اعوجاج الحاجز الانفي وتضخم غضاريف ‏الانف

History:
Male patient presented with neck swelling on the right side of the neck at the level of thyroid cartilage months ago. No history of fever or dysphagia or dysnea or stridor. No history of neck anomalies. No history of previous operation or medical disease. No history of drug allergy.
Examination:
External neck examination showed neck swelling 3×4 cm in size , smooth surface, not attached to surrounding strucure or overlying skin, not pulsatile, compressible , not transilluminated, increase in size with straining and vulsalva manouvre and not painful.no other neck pathology. Neck lymph node was normal. Laryngeal framework was in normal anatomy. Moore's sign was negative.
Internal laryngeal examination with 70 degree endoscopy was normal. no obstructing lesion or mass in the ventricle or the opening of saccule.
Differential diagnosis:
From other neck swelling like:
Lymph node ( not compressible or increasing with valsalva manouvre)
Carotide body tumer( transmitted pulsation)
Malignant swelling.(attached to surroundig and hard in consistency)
Sebaceous cyst( attached to the skin)
Lipoma( soft and slippery edges).
Investigation:
Ct scan of the neck axial and saggital and coronal. Ct axial cuts showed cystic swelling filled with air with rounded well defined edges existing from thyrohyoid membrane and extending outside to the neck and inside to the ventricle. Normal neck structures.
Diagnosis:
Most probably laryngocele of mixed type ( internal and external)
Managment:
Preparation of the patient to excision.
Neck incision at the level of thyroid cartilage. Elevation of subplatysmal flap. Reaching the level of thyrohyoid membrane the dissection of the mass from surrounding then track the swelling through the membrane and we can facilitate the excision by doing a laryngofissure.