Laryngeal webs and laryngotracheoesophageal clefts: State of the art

Surgical management of complex neonatal airway abnormalities

PURPOSE OF REVIEW

The neonatal airway is subject to a variety of developmental abnormalities with a wide range of complexity. Symptomatic pathologies present in a spectrum ranging from simple noisy breathing or poor feeding to frank respiratory distress. Diagnosis requires a high index of suspicion, characterization of noisy breathing, and identification of obstructive symptoms such as increased work of breathing, retractions, and difficulty feeding. Surgical management is directed by the pathology.

RECENT FINDINGS

The past several years have seen an expansion of surgical innovation as endoscopic and open techniques have evolved. We reviewed articles related to neonatal and infant airway diagnoses since 2020 with the goal of providing a current review and update of developing techniques. Specifically, we discuss some of the exciting trends in surgical management of vocal fold paralysis, laryngeal clefts, subglottic stenosis, tracheobronchomalacia as well as the role of ex utero intrapartum therapy (EXIT procedures).

SUMMARY

An underlying theme in evolving surgical management is the exciting advancements in technology, including 3-D printing, and expansion of minimally invasive endoscopic techniques. Though some of these developments are in the initial stages of utilization, they may be potential sources to transform surgical management in the future.

Case Report: A Rare Cause of Stridor and Hoarseness in Infants-Congenital Laryngeal Web

BACKGROUND

Congenital laryngeal web is a rare disease that can cause stridor, dyspnea, hoarseness, and other symptoms. Children with this disease generally have stridor, weak crying, and hoarseness at birth, but these symptoms can also occur during the days, weeks, months, and even years after birth. Respiratory tract infection will obviously aggravate these manifestations, and recovery is slow after symptomatic treatment. Neck CT and laryngoscopy can detect and diagnose this disease. It is important that the disease can be considered and examined in infants with recurrent stridor and persistent hoarseness after birth.

CASE SUMMARY

We report a 23-month-old boy who was admitted to hospital due to stridor and hoarseness after birth. Combined with the results of laryngoscopy, he was diagnosed with congenital laryngeal web, and was treated with carbon dioxide (CO₂) laser and cryotherapy by bronchoscope. The prognosis was good.

CONCLUSION

Congenital laryngeal web is a rare but challenging laryngeal lesion. It is very important that the disease can be considered and examined for infants with recurrent stridor and persistent hoarseness after birth. The treatment strategy after diagnosis should be determined according to the classification of laryngeal web and the severity of children's symptoms.