Diagnosis and Operative Techniques in pediatric vallecular cysts：Total versus Partial Resection

Background: To review the diagnosis and surgery treatment of vallecular cysts in children, and to further investigate the safety and prognostic outcomes of different surgical approaches (partial vs. total resection). Methods: A retrospective analysis was conducted on 93 children with vallecular cysts who underwent endoscopic temperature-controlled plasma radiofrequency ablation at Beijing Children's Hospital between January 2019 and December 2022. Patients were categorized into a partial resection group (n=36) and a total resection group (n=57). Clinical characteristics, operative time and recurrence (with a minimum follow-up of one year) were compared between the groups. Results: The age of the patients ranged from 3 days to 14 years, the median patient age was 6.6 months. A statistically significant difference was observed in the mean operative time between the two groups: 21.2 ± 8.8 minutes for partial resection versus 45.4 ± 18.9 minutes for total resection (r=0.001). Intraoperative blood loss was minimal in all cases. During follow-up, recurrence occurred in only 2 patients (5.56%) in the partial resection group, with no further recurrence after a second procedure. No recurrences were observed in the total resection group. No serious anesthetic or surgical complications occurred. Conclusions: Electronic laryngoscopy combined with neck ultrasonography is the preferred diagnostic approach. Temperature-controlled plasma radiofrequency ablation/coblation under suspension laryngoscopy is a safe and effective treatment for pediatric vallecular cysts. Partial resection, characterized by shorter operative time and minimal trauma, is a safe and effective option for neonates, infants, and complex cases with comorbidities such as laryngomalacia. However, given the higher recurrence rate and greater surgical tolerance in older children, total resection is strongly recommended to minimize recurrence risk. The choice of surgical technique should be individualized based on the child's age, cyst characteristics, and overall clinical status.