Congenital vallecular cyst presenting with persistent stridor and feeding difficulty since the neonatal period: a case report

Introduction and importance: Congenital vallecular cysts are rare but potentially life-threatening causes of upper airway obstruction in infants. They typically present with persistent stridor and feeding difficulty and may be misdiagnosed as laryngomalacia, delaying definitive management. Case presentation: A 3-month-old male presented with persistent stridor and feeding difficulty since birth. Computed tomography of the neck revealed a cystic lesion at the base of the tongue, causing airway narrowing. Flexible laryngoscopy confirmed a vallecular cyst. The patient underwent surgical marsupialization under general anesthesia, with complete resolution of symptoms. At 1- and 5-month postoperative follow-ups (4 and 8 months of age), he remained asymptomatic with normal growth and development. Telephone follow-up at 2 years and 1 month of age confirmed sustained resolution of symptoms without recurrence. Clinical discussion: Vallecular cysts should be suspected in infants with persistent stridor accompanied by feeding difficulty. While laryngomalacia is the most common cause of infantile stridor, associated feeding problems warrant early endoscopic evaluation to exclude structural lesions. Surgical marsupialization of vallecular cysts provides definitive treatment with excellent outcomes. Conclusion: Early endoscopic evaluation and timely surgical marsupialization of vallecular cysts are essential to prevent airway compromise and ensure favorable long-term outcomes.