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subglottic web

This 7 years female child came to the ENT OPD with difficulty in breathing for which tracheostomy was performed. The 90 degree telescopic examination showed web formation at subglottic area.The CT scan revealed obliteration of airway and confirmed our clinical diagnosis of web formation at the subglottic area. Considering the age of the patient the endoscopic rout of surgery was done. The General anesthesia was given through the tracheostomy tube. The anterior commissure laryngoscope was introduced beyond the vocal cords. Then a suitable size pediatric bronchoscope was introduced through the laryngoscope till reaches upto the subglottic web. Both the bronchoscope and laryngoscope were held by the left hand as a single unit. A membranous web was confirmed by the touch feeling of metallic suction cannula. A thin size small number gum elastic bougie was passed through the small opening of subglottic web and the web was dilated with increasing numbers of gum elastic bougies till the air way became adequately dilated. The glow of bronchoscope light was seen at the trachea and bougie was touching the tracheostomy tube through the patent and adequately dilated airway.The MItomycin C was applied at the web area.The post operative CT scan showed the adequate size patent airway. The post operative period was uneventful and long term follow-up of 7 years did not show any web reformation or the stenosis of the airway. Thankyou very much Dr. Vikas Sinha Professor ENT