Materials and methods
The retrospective analysis was conducted on a total of 10 children
diagnosed with the congenital laryngeal web. These children were
admitted to our department between 2010 and 2020. Of 10 children, 3 had
type I and II laryngeal web(Figure1-D) while the other 7 children had
type III and VI congenital laryngeal web(Figure1-A、B、C). Of the 3
children with type I and II laryngeal web, all were females, whereas, in
seven children with type III and IV laryngeal web(Table-1), six were
male, and one was female. The oldest child with type I and II laryngeal
web was five years old at the time of presentation, while the youngest
one was only 1 year and 9 months old. The children were clinically
presented with persistent hoarseness and no obvious respiratory
distress. Although three children at our hospital did not undergo a
tracheotomy, all of them recovered from a single endoscopic procedure.
The seven children with type III and IV laryngeal web in our study were
aged 2 years and 2 months old at the time of their presentation to our
hospital, while the youngest one was 1 month old, with a mean age of 13
months. The tracheotomy was
performed early, at an age ranging between 1 and 11 months, in all seven
cases. In one of the seven children, we observed a combined atrial
septal defect, while in another case, both atrial septal defect and
laryngomalacia were observed. Six children out of the seven displayed
subglottic stenosis, while one had vocal cord paralysis. Among the six
children, four had an area of subglottic stenosis greater than
90%(cotton III°), while the other two had 40% (cotton
I°)subglottic stenosis.
All the 3 children with type I and
II laryngeal web recovered after a single endoscopic procedure. The
other seven children with type III and IV laryngeal web eventually
recovered in our hospital through open laryngoplasty and were
successfully extubated with the tracheal tube. The preoperative enhanced
CT of the neck was performed in all cases(Figure-2), which suggested
varying degrees of stenosis in the glottic portion and also below the
glottis. The youngest of the seven children with laryngeal web type III
and IV who received open laryngoplasty was of age 1 year and 1 month; in
contrast, the oldest was of 2 years and 11 months, with the majority of
children being around 2 years of age. In all seven cases, a T-tube was
implanted intraoperatively, whereas, in the six children with subglottic
stenosis, the cricoid cartilage was incised to remove the scar tissue
under the glottis. This cricoid cartilage was reconstructed using the
autologous rib cartilage or hyoid bone (one rib cartilage and five hyoid
bone). In one of the cases that had vocal fold paralysis, the right
vocal fold was removed, and a T-tube was placed through the original
tracheal incision. This tube was placed for 3 months in one case, 8
months in another case, and 6 months in another five cases. The T-tube
was placed slightly above the glottis, which acted as a support to
prevent the adhesions. The children presented with choking while
consuming fluids after surgery should be fed a soft or semi-liquid diet.
Also, this problem of choking on food could be solved by dietary
exercises. After placing the T-tube for a certain period, the children
had to return to the hospital for a follow-up visit and also for a
change in the regular tracheal tube. After one month of blockage, all
seven children were successfully extubated. Before surgery at our
hospital, these children had undergone multiple endoscopic or open
surgical procedures, which included a maximum of five and a minimum of
two endoscopic procedures. However, all the previous procedures were
unsuccessful in removing the tracheal tube.