Int J Pediatr Otorhinolaryngol. 2026 May 30;207:112876. doi: 10.1016/j.ijporl.2026.112876. Online ahead of print.
ABSTRACT
BACKGROUND: Congenital laryngeal webs are rare laryngeal anomalies resulting from incomplete re-canalization of the primitive larynx. They present a significant therapeutic challenge, requiring a delicate balance between establishing a patent airway and preserving vocal function. This study details a ten-year, single-surgeon experience at a tertiary care centre to evaluate the efficacy of a graded management protocol and long-term outcomes.
METHODS: A retrospective chart review was conducted for 23 pediatric patients managed for congenital laryngeal webs between 2015 and 2025. Data regarding demographics, Cohen’s classification, presenting symptoms, surgical management, and postoperative outcomes were analyzed. Treatment choice was dictated by web severity: endoscopic release for thin webs, open web release with keel placement for thick webs without subglottic extension and open reconstruction for thick webs with subglottic extension.
RESULTS: The cohort included 23 patients (10 males, 13 females) with a mean age of 4.5 years. The study population presented with severe pathology; Type III webs were the most prevalent (65.2%). Consequently, respiratory symptoms (82.6%) were more common than isolated voice abnormalities (78.2%). Management strategies included endoscopic web release (17.4%), endoscopic web release and keel placement (21.7%), open web release with keel placement (8.7%) and open laryngotracheal reconstruction (LTR) (34.8%). Post-operative airway patency was achieved in all tracheostomized patients, yielding a 100% decannulation rate (8/8). Revision surgery was required in 2 patients (1 in Type III and 1in Type IV), (8.7%). Perceptual voice analysis yielded a mean GRBAS score of G2R1B1A1S1.
CONCLUSIONS: Congenital laryngeal webs are rare but clinically significant airway anomalies that may present with a wide spectrum of respiratory and phonatory symptoms. A tailored algorithm-reserving endoscopic techniques for thin webs and open LTR for thick webs-results in excellent decannulation rates. Overall, a multidisciplinary approach with careful surgical technique and long-term follow-up is essential to optimize both airway stability and voice outcomes in children with congenital laryngeal webs.
PMID:42263361 | DOI:10.1016/j.ijporl.2026.112876
