title: Congenital glottic web: management and anatomical observation.
abstract: BACKGROUND
  Congenital anterior glottis web is a rare congenital laryngeal anomaly presenting usually by either dysphonia or airway obstruction. Several ways for managing this condition have been proposed including endoscopic, as well as external techniques.
  
  
  OBJECTIVE
  The purpose of this study is to present our experience and to review the experience of others with cases of congenital glottic web regarding their diagnosis, classification and management.
  
  
  METHODS
  It is a retrospective study, which included six infants and children; two groups were identified; first group included 3 patients who were treated by endoscopic laser lysis of webs, followed by topical application of mitomycin C (MMC) to the fresh wound, and the other group included 3 patients who underwent open surgical correction, by Laryngotracheal reconstruction (LTR). Information recorded included; age, sex, presentation, grading of lesions, surgery performed, residual web, and outcome. Assessment and documentation of subglottic extension independent from the glottic extension of the web was also done.
  
  
  RESULTS
  All webs were grade 2, 3 and 4 according to Cohen's classification. We observed in five cases that high grade webs (grade 3 and 4) usually had thick subglottic extension, but in one case (case 2 laser) high grade web (grade 4) had thin subglottic extension. Complications included; two recurrences one after laser surgery and the other one after LTR. All appropriate patients were decannulated post LTR.
  
  
  CONCLUSIONS
  Use of laser and MMC is good in thin glottic webs; LTR is indicated in glottic webs with thick subglottic extension. Not all high grade webs have thick subglottic extension. So, thickness of web and subglottic extension has to be assessed during microlaryngeal surgery, by laser incision and examination of web thickness to determine the appropriate management.
authors.affiliation: Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amir
authors.forename: Tamer
authors.initials: T
authors.lastname: Youssef
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D005931:Glottis / Q000002:abnormalities* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007828:Laryngoscopy / Q000379:methods; D007829:Laryngostenosis / Q000145:classification / Q000473:pathology / Q000601:surgery; D053685:Laser Therapy / Q000379:methods; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index