Isolated congenital laryngeal web

Isolated congenital laryngeal web is a rare congenital malformation of the larynx in which a thin membrane (web) of tissue spans part or all of the glottis, the area between the vocal cords. This condition results from incomplete recanalization of the laryngeal lumen during embryonic development, typically between the 8th and 10th weeks of gestation. The web most commonly forms at the level of the true vocal cords (glottic web), though subglottic and supraglottic webs can also occur. The term "isolated" distinguishes this condition from laryngeal webs that occur as part of broader syndromes, such as velocardiofacial syndrome (22q11.2 deletion syndrome). The severity of symptoms depends on the thickness and extent of the web. Key clinical features include an abnormal cry (weak, hoarse, or absent) at birth, stridor (noisy breathing), varying degrees of airway obstruction, and dysphonia (voice abnormality). In mild cases, the web may be thin and involve only the anterior portion of the glottis, causing primarily voice changes. In severe cases, a thick web may obstruct a significant portion of the airway, leading to respiratory distress that requires urgent intervention in the neonatal period. Treatment depends on the severity of the web. Thin, small webs may be managed endoscopically using cold steel instruments or laser division, sometimes with placement of a keel to prevent re-formation of the web. More extensive or thicker webs may require open surgical approaches, such as laryngofissure with keel placement, or tracheotomy to secure the airway while staged reconstructive procedures are performed. Long-term outcomes are generally favorable for mild to moderate webs, though voice quality may remain affected. Regular follow-up with otolaryngology is important to monitor for web recurrence and to optimize voice and airway outcomes.

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