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LARYNGEAL WEBS

“Welcome, medical students. Today, we’re delving into an important topic: laryngeal webs. These are rare congenital or acquired conditions characterized by a thin membrane that forms across the larynx, particularly at the level of the vocal cords. Let’s break down the details, from the types to clinical presentation, diagnosis, and management. First, let’s start with the types of laryngeal webs. Laryngeal webs can be congenital or acquired. • Congenital laryngeal webs develop during fetal development due to incomplete recanalization of the laryngeal lumen, often around the 10th week of gestation. They typically appear at the level of the glottis, but can also occur in the subglottic or supraglottic regions. • Acquired laryngeal webs, on the other hand, often result from trauma, such as prolonged endotracheal intubation, laryngeal surgery, or infections like laryngeal diphtheria. These injuries can lead to scar formation and the development of webs. Clinically, the presentation of laryngeal webs depends on the degree of obstruction. • Mild webs might be asymptomatic or present with mild hoarseness or stridor, which is more pronounced during inspiration. • In more severe cases, especially those with over 50% obstruction, patients can present with respiratory distress or aphonia, particularly in infants and young children. • In adults, symptoms might include progressive hoarseness or a weak cry, depending on the web’s extent and location. Now, let’s move to diagnosis. • Laryngoscopy is the gold standard for identifying laryngeal webs. Flexible or direct laryngoscopy allows visualization of the membrane, its location, and the extent of obstruction. • In some cases, CT or MRI imaging might be used to assess the extent of the web, especially if subglottic involvement is suspected. These imaging modalities can also help differentiate laryngeal webs from other conditions like subglottic stenosis or tumors. • Voice analysis can be useful in cases where there is partial obstruction, helping to evaluate the impact on vocal quality and providing insights into the severity of the condition. When it comes to management, treatment depends on the severity of the web. • For mild or asymptomatic cases, close monitoring may be appropriate, especially if the web is not significantly impacting breathing or vocal function. • Surgical intervention is necessary for symptomatic webs, especially those causing significant airway obstruction. Options include microlaryngeal surgery to excise the web using cold instruments or CO2 laser surgery for precision removal of the webbing tissue. • In cases where the web is extensive, laryngotracheal reconstruction or cricotracheal resection may be required. These procedures aim to widen the airway and are often performed in stages. • Post-surgery, stent placement may be considered to prevent reformation of the web, although this comes with a risk of complications like granulation tissue formation. • Voice therapy post-intervention is critical, as it helps patients regain optimal vocal function and recover from the effects of both the condition and the surgery. It’s important to note that early identification and intervention in congenital cases can significantly improve outcomes, especially in infants where airway obstruction can be life-threatening. Close follow-up is key, as some patients may experience recurrence of the web despite surgical removal. That wraps up our discussion on laryngeal webs, from their types to detailed management approaches. Understanding these complexities will help you in both diagnosing and treating this rare but important condition. Thanks for tuning in, and I’ll see you in the next session where we continue to explore advanced ENT topics!”