Definition:
Congenital web is a medical condition in which the child's trachea (windpipe) is obstructed due to formation of a layer of web-like tissue, which results in breathing difficulties and other symptoms.
Causes:
Incomplete canalization of the laryngeal lumen.
It is congenital, i.e it presents since birth, but is could be acquired in some cases.
Pathology:
- Commonest site is glottic, may extend to subglottis.
- May be small, large, or imperforate fibrous ring.
Symptoms:
- Small web: asymptomatic, hoarse cry, mild stridor.
- Large web: weak hoarse cry, evident stridor.
- Imperforate web: Cyanosis with no cry usually fatal.
Signs:
- Flexible or direct laryngoscopy: symmetrical grayish white membrane may be a semi translucent triangular band, or thick membrane.
Treatment of Congenital web:
A. Mild if no symptoms ………… no treatment.
B. Severe:
- Tracheostomy if severe obstruction.
- Excision of web by:
- Microlaryngosurgery (MLS) using laser or cold instrument.
- Laryngofissure in very thick web
C: Imperforate web: Urgent tracheostomy or rigid bronchoscope to rupture the web.