Clinical Staging of Combined Laryngoceles: Proposal of a Novel Classification Concept

Background Laryngocele was first described by Virchow in 1867 as a herniation of the laryngeal ventricle ( laryngocele ventricularis ). Dominique Larrey had earlier used the term goitre aériennes to describe this condition. Aim To propose a clinical staging system for combined laryngoceles based on the extent of internal anatomical extension and to validate this system through clinical, endoscopic, and radiological correlations. Patients and Methods: A retrospective study was conducted on 24 patients with combined laryngoceles admitted to the Otorhinolaryngology Department, Mansoura University Hospital, Egypt, between 1998 and 2022. Clinical presentation, endoscopic findings, and imaging results were analyzed to evaluate and validate the proposed staging system. Results All patients presented with an external component. Sixteen cases were classified as stage V1 (ventricle involvement), 66.7% as stage V2 (ventricle and vestibule involvement), and 16.7% as stage V3 (ventricle, vestibule, and vallecula involvement). Dysphonia, aerodigestive obstruction, and dysphagia did not differ significantly between cases with or without air content. However, stridor and dyspnea were more frequent in air-containing laryngoceles. Endoscopic grading was not significantly affected by air content. Conclusion The proposed clinical staging system for combined laryngoceles (V1, V2, V3) is simple, feasible, and reliable. Validation through clinical, endoscopic, and radiological findings supports its potential as a practical tool for standardized assessment.