Laryngeal Web
A laryngeal web is a congenital (present at birth) abnormality. It forms when the baby is developing in the early stages in the mother’s womb and fails to disappear as the baby continues to grow. A laryngeal web stretches between the vocal cords (also called vocal folds), which are located in the larynx. It restricts the trachea (windpipe), causing breathing difficulties and respiratory distress. It can also affect your child’s voice.They are uncommon, constituting 5% of all congenital laryngeal lesions; their incidence has been estimated at approximately 1 in 10,000 births. They are due to incomplete recanalization of the laryngotracheal tube during the third month of gestation, leading to different degrees of laryngeal webs. The most common site of development is at the level of the vocal folds anteriorly, although they may occur in the posterior interarytenoid or in the subglottic or supraglottic area. Most congenital webs present at birth or in the first few months of life.
Signs and symptoms of Laryngeal Web
- Abnormal cry (weak, soft or absent)
- Abnormal voice (high pitched or weak)
- Chest infections
- Croup (barking cough)
- Hoarseness
- Shortness of breath
- Respiratory distress
- Wheezing
Diagnosis
The only way to diagnose the extent of the web correctly is by direct laryngoscopy under general anesthesia. It is important to detect associated anomalies of the larynx, the respiratory tract, and other organ systems.
Treatment
Treatment of laryngeal webs depends on the thickness of the web. Approximately 60% of patients require surgical intervention. Of all patients with laryngeal webs, 30 to 40% require a tracheostomy. The type of lesion dictates the surgical approach. In general, the thinner webs are easier to treat and the better the result; the more severe webs are resistant to surgical management. Thin glottic webs alone respond well to simple incision or rupture. For the remainder, obtaining a satisfactory result (judged by the voice) is difficult, as is improving the airway to achieve decannulation after a tracheotomy.
