Reports of pharyngoceles are uncommon in the literature.
The etiology of pharyngoceles often has been associated with elevations in intrapharyngeal pressure, as seen in individuals who play wind instruments; however, it has been postulated that pharyngoceles also can be a manifestation of a branchial arch anomaly, specifically a branchial sinus outpouching that may dilate over time.
(5) With proper history acquisition, physical exam, and imaging studies with normal and elevated pharyngeal pressures, pharyngoceles can be correctly diagnosed and treated appropriately.
Several options were discussed with the patient, including observation, swallowing therapy, percutaneous augmentation of the pharyngocele, and open surgical excision.
Bovine collagen (Zyplast; McGhan Medical Corp.; Fremont, Calif.) was percutaneously injected into the base of the pharyngocele under flexible fiberoptic guidance and with local anesthesia in clinic (see video at www.entjournal.com).
Patients with a pharyngocele, or a lateral pharyngeal diverticulum (LPD), exhibit local bulging through one of the weak areas of the pharynx.
Fiberoptic laryngoscopy demonstrated a 5- mm pharyngocele and food remnants in the adjacent vallecula (figure 3).
A pharyngocele can appear as a mass and is usually associated with various symptoms, including dysphagia, hoarseness, cervical pain, regurgitation, dysphonia, cough, earache, and odynophagia.
When a pharyngocele is suspected in a patient with such a clinical history, the diagnosis can be confirmed by various imaging studies, including plain x-rays, barium swallow, endoscopy, computed tomography (CT), and magnetic resonance imaging (MRI).
Several unusual BAs have been reported, including retropharyngeal abscesses, (2,3,20) pharyngoceles
, (4) duplicate middle ear ossicles, (5) and intrathyroidal masses and abscesses.
Both laryngoceles and pharyngoceles can change size and appearance with variations in internal pressure.
Air-filled neck masses that arise in the pharynx (commonly in the region of the pyriform sinuses) and lack an intralaryngeal component or origin should be called pharyngoceles. Those that arise in the laryngeal ventricle should be called laryngoceles.