Congenital Glottic Webs in Children

Abstract

This study is a retrospective review of congenital glottic webs in children. Its purpose is to clarify the controversial aspects of this lesion and to offer a more definitive approach to its treatment. The study includes discussions of embryology and anatomy, a thorough literature review, and a detailed statistical analysis of patient data. Fifty-one pediatric cases are reported, with symptoms and endoscopic findings described in detail. Treatment with dilatations, incisions (knife, scissors, laser), stenting, and external laryngeal surgery with keel insertion are evaluated, and results of therapy, both before and after the development of laser surgery, are reported. Of the 51 patients, 22 required tracheotomy and all who completed therapy were ultimately decannulated. Vocal dysfunction was the most difficult symptom to treat, and perfection of the voice was attained only infrequently. However, the ultimate results of therapy, as noted in this series of patients, should counter the pessimistic viewpoints expressed in the literature.

The combined endoscopic management of congenital laryngeal web

“…Benjamin proposed a staging system based on the location of the web within the larynx describing glottic, supraglottic, subglottic and interarytenoid stenoses [1]. Cohen's type 1 defines an anterior web involving less than 35%, type 2 involving 35-50%, type 3 50-75%, and type 4 75-90% of the glottis [3]. Accordingly, our case was a severe glotto-subglottic, Cohen's type 4 web.…”

“…Since 1980 Cotton's laryngotracheal reconstruction (LTR) has been believed to provide the best results for the problem. This operation involves augmentation of the laryngotracheal complex by anterior and posterior midline incision of the cricoid and thyroid cartilages with insertion of costal cartilage grafts to expand the airway [2][3][4]15,21].…”

“…Recently the external laryngotracheal reconstruction (LTR) with tracheostomy is kept to be the most effective procedure. Through a laryngofissure a costal cartilage graft with stent or keel is inserted [2][3][4]15,21]. This means however a significant demand for the children with the problem of donor site morbidity and a long-term tracheotomy or intubation [13].…”

Congenital subglottic web: a rare cause of neonatal stridor

“…Most of the published data on laryngeal webs refer to the glottic type, with or without associated congenital subglottic stenosis [1,[3][4][5], so subglottic webs seem to be extremely rare. There is some controversy regarding the embryology and classification of subglottic webs.…”

Morphometric studies and a complex airway evaluation panel for objective and reliable assesment of laryngo-tracheal stenosis surgery

“…This operation involves augmentation of the laryngotracheal complex by anterior and posterior midline incision of the cricoid and thyroid cartilages with insertion of costal cartilage grafts to expand the airway (8,9,10,11,12). Traditionally, endoscopic methods were thought to have only limited role in the treatment, especially in mild cases.…”