Laryngeal Webs

Epidemiology

Laryngeal webs (LWs) are rare lesions that result from incomplete recanalization of the embryonic larynx during the seventh to eighth week of gestation. LWs are part of a continuum of congenital laryngeal abnormalities that include laryngeal atresia and congenital subglottic stenosis, which result from varying degrees of resorption of the epithelium of the fetal larynx. LWs are associated with other congenital anomalies. One third of patients will have an associated abnormality of the respiratory tract, the most common of which is subglottic stenosis.

Clinical Findings

Seventy-five percent of LWs are located at the level of the true vocal cords. These lesions are most often located in the region of the anterior commissure. LWs may also occur in the region of the posterior commissure resulting in interarytenoid fixation. LWs have also been described to involve the supraglottic and subglottic larynx. The cricoid cartilage may be involved in patients with LWs occurring within the subglottic region.

Patients with LWs are usually symptomatic at birth and present with signs of airway obstruction. Characteristic clinical features include weak cry, aphonia, respiratory distress, and cyanosis. Stridor is an unusual presentation. Some patients may present later with symptoms believed to represent recurrent or atypical croup.