Epiglottic Cysts

These cysts are fluid filled masses that sit beneath the epiglottis. They can cause difficulties during eating and drinking, and can result in coughing , nasal discharge or even pneumonia.The cyst should be surgically removed.

Epiglottic cysts

Definition and Pathophysiology
Epiglottic cysts are congenital developmental anomalies arising from remnants of the thyroglossal duct or subepiglottic tissue. They are typically located at the base of the epiglottis, within the valleculae or subepiglottic region, and are lined by respiratory epithelium. The cysts are usually filled with serous or mucoid fluid and, depending on their size, can interfere with normal upper airway dynamics.

Clinical Presentation

Abnormal inspiratory or expiratory noise during exercise
Reduced athletic performance due to partial airway obstruction
Dysphagia or intermittent coughing, particularly with large cysts
In neonatal foals: aspiration pneumonia, difficulty nursing, and failure to thrive

Diagnosis
Upper airway endoscopy is the diagnostic gold standard. The cyst appears as a well-defined, fluctuant, fluid-filled mass at the ventral aspect of the epiglottis. Ultrasound or CT imaging may assist in surgical planning for extensive lesions.

Treatment

Transendoscopic laser excision (CO₂ or diode): preferred method due to minimal invasiveness and low recurrence rate
Surgical excision via laryngotomy for large or recurrent cysts

Prognosis
Prognosis following complete removal is excellent. Performance horses usually return to full athletic function. In foals, early intervention can prevent aspiration pneumonia and growth retardation.