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This video elucidates the procedural technique employed for endoscopic laryngeal web repair in pediatric patients, wherein a laryngeal anterior commissure stent (LACS) is inserted.
It delineates the steps of the surgical intervention, as well as the subsequent postoperative assessment by awake fiberoptic nasolaryngoscopy examination.
After the administration of general anesthesia, the patient was appropriately positioned and subjected to pediatric laryngoscopy with suspension. Spontaneous breathing was facilitated through the utilization of side port insufflation. A vocal fold retractor was applied, allowing for a comprehensive examination of the entire airway using a telescope. The laryngeal web was precisely divided using microlaryngeal knives and scissors. Subsequently, a Laryngreal Anterior Commissure Stent (LACS) was trimmed to encompass a small distance superior to the vocal folds, extending towards the caudal end of the laryngeal web. It was ensured that the stent did not exceed two-thirds of the length of the vocal folds. The Laryngreal Anterior Commissure Stent (LACS) was secured in place through endo-extralaryngeal suturing utilizing a Lichtenberger needle driver. Following the proper positioning of the LACS in its designated anatomical location, the suture was tied over a silastic button situated in the anterior neck.
Thin laryngeal web.
Thick, cartilaginous web. Not fit for general anesthesia.
Pediatric Laryngoscopy with suspension. Vocal fold retractor. Microlaryngeal knives and scissors. Lichtenberger endo-extralaryngeal needle carrier.
Pediatric laryngoscopy with suspension. Spontaneous breathing aided by side port insufflation.
Routine preoperative work up of congenital laryngeal web including genetic testing.
Laryngotracheal reconstruction with anterior rib graft if the laryngeal web is thick and extending to the subglottis.
Airway edema and respiratory distress. Laryngeal anterior commissure stent migration. Anterior commissure re-adhesion. Vocal folds granuloma and scarring. Hoarseness of voice.
None.
Lawlor CM, Dombrowski ND, Nuss RC, Rahbar R, Choi SS. Laryngeal Web in the Pediatric Population: Evaluation and Management. Otolaryngol Head Neck Surg. 2020;162(2):234-240. doi:10.1177/0194599819893985
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