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Abstract
Congenital anterior glottic web is uncommon finding in patients with respiratory distress and stridor (Cheng and Beckenham, 2009).Fleischmann first observed in 1882 this condition during an autopsy of an infant. Since then, the condition has been reported by many doctors . The presenting complaints include; lack of voice, biphasic stridor, recurrent croup or pneumonia.
Several important caveats dictate the surgical management of anterior glottic webs. A web that causes airway obstruction and hoarseness warrants surgical intervention. Excision of the web, however, will result in a situation that favors the reformation of the web. Thus it is necessary to use techniques that will physically separate the raw mucosal surfaces until full healing takes place (Benjamin, 1983).
A wide variety of treatment for anterior glottic webs has been proposed over the years with both endoscopic techniques and external approaches used. The management is usually troublesome, especially when the web is thick and large. Indications for surgical correction in such cases have been debated (Van den Broek and Brinkman , 1979).
Milczuk et al., (2000) Described 5 cases of congenital laryngeal web seen in 13 years, and in each they noted a glottic web with subglottic extension, which was described as cartilaginous in 4 patients and was managed by Laryngotracheal Reconstruction. A case of glottic web with thick subglottic extension with endoscopic lysis and topical application of mitomycin has been reported (Unal, 2004).Wyatt and Hartley, reported management of 15 cases of glottic webs with subglottic stenosis by laryngotracheal reconstruction, and they were all successfully decanulated.
If the web does not extend below the inferior edge of the true vocal cords, and the posterior commissure is normal, an endoscopic approach will often be successful (Milczuk, et al., 2000). Endoscopic techniques include; an endolaryngeal mucosal flap (McGuirt , et al., 1984), endoscopic placement of a keel (Dedo , 1979), and endoscopic modification of Dedo’s technique described by Mouney and Lyons (1985). External techniques include; laryngofissure with division of the web and keel insertion (Montgomery, 1979) or stenting and laryngotracheal reconstruction (Cotton, et al., 1989).