Pharyngocele

A pharyngocele, also known as a lateral pharyngeal diverticulum, refers to a lateral pharyngeal wall herniation in the piriform recess or vallecula 1,2.

Pharyngoceles are rare and more often unilateral than bilateral 2-4. It is commonly associated with occupational exposure to increased intra-pharyngeal pressure 1,3 such as glass blowing or playing musical woodwind/brass instruments. It occurs more frequently in males than in females and usually arises during the fifth and sixth decades of life 2,4,5.

Raised intrapharyngeal pressure secondary to 1-7:

  • playing woodwind or brass instruments
  • glass blowing
  • excessive cough

The majority of patients are asymptomatic 4,5. The primary manifestation is dysphagia 4-6 but other clinical features may include 4,6:

The two main factors involved in the pathogenesis of pharyngoceles are chronic elevation of intrapharyngeal pressure and pharyngeal wall weakness 3-6.

Most documented cases in the medical literature have an association with the repeated elevation of intrapharyngeal pressure. Patients are typically glassblowers or musicians who play woodwind or brass instruments 1-7.

Pharyngocoeles can arise from two areas of weakness on the lateral wall of the pharynx 4,5.

  1. between the superior and middle pharyngeal constrictor muscles
  2. between the middle and inferior pharyngeal constrictor muscles 4,5,7

Loss of muscle elasticity with aging and previous surgeries can contribute to the wall weakness 2-5. A minority of patients have congenital causes thought to be due to branchial cleft anomalies 2,3,7.

Pharyngocoeles may be seen on a transverse sonogram at the level of the ventricular folds 8 as a hyperechoic gas pocket which enlarges during a Valsalva maneuver 8. In pharyngoceles, gas communicates with piriform sinuses distinguishing it from laryngoceles which have gas communicating with laryngeal saccules 8. Identification of pharyngoceles on ultrasound can be difficult in the presence of thyroid calcification 8,9.

Pharyngocoeles are best identified on the frontal barium swallow x-ray during a Valsalva maneuver 2 before and after contrast administration. In bilateral pharyngoceles, a "bullfrog appearance" can be appreciated on frontal cervical x-rays 1.

CT and laryngoscopy are the diagnostic tools of choice 4,5,7. Similar to radiographs, it is best appreciated during a Valsalva maneuver after ingestion of positive oral contrast medium 7. It is typically seen as a parapharyngeal gas sac that communicates with the base of the piriform sinus or the lateral side of the vallecula 5.

Morphologically is similar to findings on CT. Dynamic real-time and 3D MRI can allow for better visualization of the anatomy, specific location and characteristics of the lesion 4,9.

Treatment is usually conservative involving healthy dietary habits, oral hygiene, avoiding activities that increase intrapharyngeal pressure and wearing a compressive neck wrap while doing those activities 2,3,6,7. Surgical excision may be indicated in severely symptomatic patients 2,3,5-7.

Article information

rID: 83075
System: Head & Neck
Tag: cases2
Synonyms or Alternate Spellings:
  • Lateral pharyngeal diverticula
  • Pharyngoceles
  • Pharyngocoeles
  • Pharyngocoele
  • Lateral pharyngeal diverticulum (LPD)

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Cases and figures

  • Case 1: combined laryngocele and pharyngocele
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