Laryngeal keel in severe congenital glottic web: case report and review of literature

Abstract

Glottic web is an abnormal soft tissue adhesion between the vocal cords which occurs due to failure of recanalisation. Congenital glottic webs comprises 5% of laryngeal anomalies. Cohen classified glottic webs into four types based on percentage of airway obliteration. Patients with severe glottic web—grade III and grade IV present with respiratory distress, stridor, phonatory difficulties or recurrent respiratory infections warranting urgent intervention. We are presenting our experience in managing two such patients with severe congenital glottic web. Diagnosis was confirmed by fibreoptic laryngoscopy under monitored anaesthetic care. Combined endoscopic excision of web with laryngofissure approach for keel stenting. In both our patients, we have used a silicone based keel for laryngeal stenting to provide strength and prevent re-webbing. During follow-up, both patients were found to have adequate phonation and normal airway thus demonstrating this method as safe option for adequate phonatory and airway outcomes.