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Congenital laryngeal web
Disease definition
A rare malformation consisting of a membrane-like structure that extends across the laryngeal lumen close to the level of the vocal cords.
ORPHA:2374
Classification level: DisorderSummary
Epidemiology
The prevalence at birth is less than 1 in 10 000.
Clinical description
Manifestations may appear at any age (hoarse or weak voice and frequent upper respiratory infections) but onset usually occurs during infancy (respiratory distress, stridor and an unusual cry). Other larynx anomalies, such as ventral laryngeal cleft and subglottic stenosis, may be associated with this malformation.
Etiology
The malformation is a result of anomalous embryologic development of the larynx, stemming from incomplete resorption of the epithelial layer that normally obliterates the developing laryngeal opening at about the sixth week of gestation. This layer is usually completely eliminated by the tenth week. Since resorption proceeds from the dorsal to the ventral side, laryngeal webs are anteriorly located, leaving a posterior lumen.
Diagnostic methods
Chromosomal and cardiovascular anomalies may also be observed in patients with a congenital laryngeal web. Accordingly, patients with a congenital laryngeal web should undergo genetic screening, which should include testing for a chromosome 22q11 deletion, and a thorough cardiovascular evaluation, which should include imaging of the aortic arch.
Genetic counseling
The pattern of inheritance of this anomaly in multiplex families is compatible with an autosomal dominant mode of inheritance.
Management and treatment
The primary goals of management for congenital laryngeal web are to provide a patent airway and to achieve a good voice quality. However, vocal cords have a tendency for fibrosis and granulation tissue formation after surgical interventions. Traditionally, the treatment of choice for laryngeal web is laryngofissure and placement of a stent or keel. Laser therapy has also been tested. Good voice quality is only achieved in patients with thin, membranous, uncomplicated webs. Treatment for thick webs, with or without associated congenital subglottic stenosis, remains unsatisfactory.
A summary on this disease is available in Deutsch (2006) Español (2006) Nederlands (2006)
Additional information