Congenital Vallecular Cysts in Children: A Systematic Review and Meta-analysis.

Abstract

To synthesize contemporary evidence on the presentation, evaluation, and surgical outcomes of congenital vallecular cysts (CVCs) in children. PubMed, MEDLINE, Embase, and Scopus were searched from 1992 to 2024 following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Eligible studies described CVCs in patients <18 years with extractable data on demographics, presentation, imaging, management, or outcomes. Two reviewers independently screened and extracted data; discrepancies were adjudicated by a third. Random-effects proportional meta-analyses using Freeman-Tukey transformation generated pooled estimates for presentation, imaging, and procedures. Recurrence and repeat excision were examined with mixed-effects meta-regression comparing marsupialization versus non-marsupialization. Temporal practice patterns were summarized descriptively by publication period (1994-2008 vs 2009-2024). Fifty-four studies encompassing 362 children met inclusion criteria. Mean age at diagnosis was 3.3 months; 54% were male. Stridor predominated (236/362, 65.2%), and flexible fiberoptic laryngoscopy was performed in 287/362 cases (79.3%). Marsupialization was the most common intervention (288/362, 79.6%), whereas non-marsupialization techniques were used in 72/362 cases (19.9%). Meta-regression showed significantly higher predicted recurrence with non-marsupialization versus marsupialization (10.13% vs 2.78%; P = .008), while predicted repeat excision did not differ significantly between groups (6.33% vs 2.08%; P = .062). CVC typically presents in early infancy with stridor and feeding difficulty. Flexible laryngoscopy is central to diagnosis, and endoscopic marsupialization provides durable resolution with significantly lower recurrence risk compared to non-marsupialization techniques.