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.