Case Report

By Dr. Balasubramanian Thiagarajan , Dr. Sanjay Kumar
Corresponding Author Dr. Balasubramanian Thiagarajan
Department of otolaryngology, Stanley Medical College, Chennai Tamilnadu, sreemagal, 20 I street, officers colony, rajaram metha nagar - India 600029
Submitting Author Dr. Balasubramanian Thiagarajan
Other Authors Dr. Sanjay Kumar
Otolaryngology, Kilpaulk Medical College, Chennai, Tamilnadu India, - India


External laryngocele, Repair, Tissue glue

Thiagarajan B, Kumar S. Novel Use of Tissue Glue in Repair of Rent in Thyrohyoid Membrane After Excision of External Laryngocele. WebmedCentral OTORHINOLARYNGOLOGY 2012;3(4):WMC003276
doi: 10.9754/journal.wmc.2012.003276

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submitted on: 19 Apr 2012 11:16:03 AM GMT
Published on: 19 Apr 2012 04:46:41 PM GMT


This paper narrates our experience of using tissue glue to seal the rent in thyrohyoid membrane following excision of external laryngocele. Thyrohyoid membrane is highly elastic, and this elasticity makes suturing the rent in the membrane very difficult. We used tissue glue with success to seal the rent.


Laryngocele is defined as an anamolous air sack communicating with the ventricle “Virchow 1863”. It is usually located between the false cord and the inner surface of thyoid cartilage [1]. Three types of laryngoceles have been described:
1. Internal – Present between the false and true vocal folds
2. External – Presents itself in the neck through a rent in thyrohyoid membrane
3. Combined – This type has both internal and external components.
In this paper we discuss the surgical management of external laryngocele. We used tissue glue to seal the rent in the thyrohyoid ligament after removal of the mass.

Case Report

40 years old male patient came to our department with complaints of:
Swelling over the left side of the neck just below the angle of mandible of 5 years duration.
There was no associated pain. The swelling showed regression and increase in sizes during varying intervals. Patient had no difficulty in swallowing, and his speech was also normal.
On examination: A soft globular mass measuring 5 cms x 3 cms just below the angle of the mandible. It was reducible. It increased in size when the patient performed valsalva manuever.

Surgical Procedure

Through skin crease incision in the left side of neck just below the mandible flap was elevated in the subplatysmal plane. Submandibular salivary gland was retracted out of the surgical field. The sac was identified and was resected. The rent in the thyrohyoid membrane was sealed with tissue glue and the neck wound was closed in layers.


Tissue glue was first introduced by Tennessee Eastman lab in 1964 for industrial purposes. This same glue was used by Amrican Military to seal the wound of soldiers who got injured during Vietnam war in 1966 [3]. Tissue glue has been used with reasonable amount of success in closing episiotomy wounds [2].
Histoacryl blue (n-butyl cyanoacrylate) was used extensively in Europe during the 1970's for surgical applications in middle ear surgery, and CSF leak repair.
In this surgical procedure we used isobutyl based cyanoacrylate glue [4]. It has the advantage of fast setting and does not evoke granulomatous reactions. The presence of fibrin in the glue enhances wound healing by stimulating neovascularization and fibroblast proliferation.
Glue should be applied via a syringe using 27 gauge needle in droplet form. Thick application donot enhance bonding and tend to crack and loosen prematurely.
Thyrohyoid membrane is very elastic and hence repairing the rent after removal of laryngocele is a difficult task. Hence we used fibrin based tissue glue to seal the rent.


2. 2.Adoni A & Anteby “Use of Histoacryl for episotomy repair” British journal of Ob Gyn volume 98 May 1991.
3. Quinn J & Kissack J “Use of tissue adhesives for laceration repair during sports event. “Clinical journal of sports medicine volume 4 No 4 1994.
4. Tissue glue in endoscopic surgery Wallviener D Rimbachs Rev FR Gynecol Obstet 1995 Nov.

Source(s) of Funding

This article did not receive any funding from any agency

Competing Interests

Authors have no competing interest pertaining to the views expressed in this article


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