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Laryngeal web — Clinical Guidelines

Overview

Laryngeal webs are abnormal fibrous bands that can form within the larynx, potentially obstructing the airway and affecting voice quality. These conditions can be congenital or acquired and require careful management to restore normal speech and airway function. 8

Diagnosis

Clinical Examination: Identification of web-like structures obstructing the laryngeal lumen.

Imaging: High-definition imaging, stroboscopy, and narrow-band imaging to assess extent and impact on vocal folds. 3

Histopathology: Biopsy and pathology examination for definitive diagnosis, using WHO classification for grading dysplasia. 3 4

Management

Surgical Intervention: Endolaryngeal mucosal flap creation using CO2 laser under microscopic control is preferred for restoring normal speech and airway. 8

Speech Therapy: Postoperative speech therapy may be necessary for some patients to achieve normal speech, particularly if initial results are suboptimal. 8

Microsurgical Resection: For associated epithelial hyperplastic laryngeal lesions, microsurgical resection tailored to infiltration depth is indicated. 3

Special Populations

Pediatrics: No specific details provided in the abstracts regarding pediatric management of laryngeal webs.

Elderly: No specific considerations mentioned for elderly patients in the provided abstracts.

Comorbidities: Management strategies do not explicitly address comorbidities, though careful surgical technique is emphasized to minimize sequelae. 3 8

Key Recommendations

Utilize endolaryngeal mucosal flap creation with CO2 laser for surgical treatment of laryngeal webs to achieve normal speech and airway patency. (Evidence: Expert opinion 8)

Implement postoperative speech therapy when necessary to optimize vocal outcomes, especially if initial results are not satisfactory. (Evidence: Expert opinion 8)

Employ microsurgical techniques for resection of associated laryngeal epithelial hyperplastic lesions, adjusting resection depth according to lesion infiltration. (Evidence: Moderate 3)

References

1 Enver N, Doruk C, Kara E, Kaşali K, Asliyuksek H, Basaran B. Does Size Matter in Laryngology? Relation Between Body Height and Laryngeal Morphometry. Journal of voice : official journal of the Voice Foundation 2021. link 2 Yaghobian S, Ohannessian R, Mathieu-Fritz A, Moulin T. National survey of telemedicine education and training in medical schools in France. Journal of telemedicine and telecare 2020. link 3 Garrel R, Uro Coste E, Costes-Martineau V, Woisard V, Atallah I, Remacle M. Vocal-fold leukoplakia and dysplasia. Mini-review by the French Society of Phoniatrics and Laryngology (SFPL). European annals of otorhinolaryngology, head and neck diseases 2020. link 4 Sarioglu S, Cakalagaoglu F, Elagoz S, Han U, Etit D, Hucumenoglu S et al.. Inter-observer agreement in laryngeal pre-neoplastic lesions. Head and neck pathology 2010. link 5 Tiong TS. Should clinical normality be examined in medical course?. Singapore medical journal 2008. link 6 Kleinsasser NH, Wild PJ, Pérez Alvarez JC, Seidler TO, Schurr C, Froelich K et al.. Extrusion forces of resorbable tacks and titanium screws in laryngeal chondrosynthesis. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2007. link 7 St-Hilaire M, Nsegbe E, Gagnon-Gervais K, Samson N, Moreau-Bussière F, Fortier PH et al.. Laryngeal chemoreflexes induced by acid, water, and saline in nonsedated newborn lambs during quiet sleep. Journal of applied physiology (Bethesda, Md. : 1985) 2005. link 8 McGuirt WF, Salmon J, Blalock D. Normal speech for patients with laryngeal webs: an achievable goal. The Laryngoscope 1984. link

Laryngeal web