Introduction: Laryngopyoceles are rare infected laryngoceles that may cause acute upper airway obstruction. Conventional management includes external excision or endoscopic marsupialisation, often with airway protection. We report an obstructing mixed laryngopyocele managed by awake transoral aspiration under flexible endoscopic guidance, avoiding emergency tracheostomy, Methods: A 68-year-old lifelong smoker with herpes simplex oesophageal stricture presented with three weeks of progressive dyspnoea, dysphonia and stridor. Flexible nasoendoscopy showed a large right supraglottic swelling involving the aryepiglottic fold, obscuring the vocal cords and causing impending airway compromise. Contrast-enhanced CT confirmed a large right-sided mixed laryngopyocele with infective features, Results: Urgent awake transoral aspiration was performed under local anaesthesia using flexible nasoendoscopic visualisation. Immediate decompression produced rapid improvement in airway patency, resolution of stridor and marked symptomatic relief. The procedure was well tolerated, with no peri-procedural complications, and emergency tracheostomy was avoided,Conclusion: Laryngopyocele should be considered in acute supraglottic airway obstruction, particularly in patients with stridor. Awake transoral aspiration under flexible endoscopic guidance offers a rapid, minimally invasive, airway-stabilising intervention in selected patients. To our knowledge, following review of the available literature, no previous report describing this technique as a primary airway-stabilising intervention has been identified.

Dr. Ahmed Khursheed is currently working as a Specialty Doctor in ENT at Countess of Chester Hospital. He has completed the MRCS ENT qualification and has worked across various hospitals in the UK to gain broad experience in otolaryngology. His interests include emergency airway management, laryngology and head and neck surgery.