ENT

1. Congenital
Anomalies of Larynx
BY NIROSHNI SUSAN

2. Laryngomalacia
Most common congenital laryngeal anomaly.
MC cause of stridor in newborns.
manifests at birth or soon after, and usually disappears
by 2 years of age.
Characterized by congenital softening(flaccid) of the
tissues of the larynx (voice box) above the vocal cords
leading to collapse of airway inwards during inspiration
resulting in airway obstruction .

3. SYMPTOMS
Inspiratory stridor which is increased on crying but
subsides on placing the child in prone position.
Normal cry
DIAGNOSIS
Direct FLEXIBLE laryngoscopy :elongated epiglottis, curled
upon itself (omega-shaped Ω), floppy aryepiglottic folds and
prominent arytenoids

5. TREATMENT
Mostly, treatment is conservative.
Tracheostomy may be required for some cases of
severe respiratory obstruction
 Supraglottoplasty is required in cases of severe
laryngomalacia.

6. Congenital Vocal fold paralysis
It is the second most common cause of stridor in the
newborn after laryngomalacia.
2 main causes:
It results from birth trauma when recurrent laryngeal
nerve is stretched during breech or forceps delivery
anomalies of the central nervous system(The most
common causative factors include entities such as: Arnold
Chiari malformations, Hydrocephalus)
Many paralyses are idiopathic in up to 47% of cases

7. Symptoms
The most common symptom is stridor.
Ineffective cough, aspiration.
Voice and cry, however, may be normal
particularly in cases of bilateral vocal
cord paralysis.
Hoarseness and dysphonia are
common in cases of unilateral vocal fold
paralysis.

8. Management strategies depend on the
child’s underlying condition.
The management of unilateral vocal cord paralysis in
children is usually conservative.
Children with bilateral vocal fold paralysis frequently
require surgical intervention. The airway is often markedly
compromised and in over 50% of cases a tracheostomy is
required.

9. Congenital Subglottic Stenosis
it is the third most common congenital airway
problem (after laryngomalacia and vocal cord
paralysis).
Congenital SGS is thought to be secondary to
abnormal thickening of cricoid cartilage or fibrous
tissue seen below the vocal cords.
SGS is considered congenital if there is no history of
endotracheal intubation or other forms of laryngeal
trauma and if present from birth.

10.  Symptoms:
• Child may remain asymptomatic till upper respiratory
infection causes dyspnea and stridor.
• Cry is normal
 Diagnosis: subglottic diameter is less than 4 mm in
full-term neonate (normal 4.5–5.5 mm) or 3 mm in
premature neonate (normal 3.5 mm)
Management: Many cases of congenital stenosis
improve as the larynx grows but some may require
surgery.

11. Laryngocele
-dilatation of laryngeal saccule
-Laryngoceles tend to occur in
musicians who play wind
instruments(trumpet)
-Laryngoceles are filled with air
but they can become infected
(laryngopyocele) when filled
with mucoid fluid.

12. 1. Internal laryngoceles :are within the larynx itself and
causes bulging of false vocal cord - hoarseness
2. External laryngoceles: penetrate the thyrohyoid
membrane – lateral neck mass
3. Combined
Diagnosis: CT as smooth, ovoid, low-density masses
Treatment of laryngoceles is excision.

13. Laryngeal web
It is due to incomplete recanalization of larynx.
Mostly, the web is seen between the vocal cords and has a concave
posterior margin.

14. Symptoms: stridor, weak cry
Treatment depends on the thickness of the web.
• Thin webs can be cut with a knife or CO2 laser.
• Thick ones may require excision via laryngofissure
and placement of a silicon keel to prevent adhesions.

15. Subglottic hemangioma
patient is asymptomatic till 3–6 months of age
when hemangioma begins to increase in size.
Patient may present with stridor but has a normal
cry. Agitation of the patient or crying may increase
airway obstruction.
About 50% of the children have associated
cutaneous hemangiomas.

16. Direct laryngoscopy :shows reddish-blue mass below the vocal
cords.
Depending on individual case, the treatment is:
(a) Tracheostomy and observation, as many hemangiomas
involute spontaneously.
(b) Steroid therapy: Dexamethasone 1 mg/kg/day for
1 week and then prednisolone 3 mg/kg in divided
doses for 1 year.
(c) CO2 laser excision: if lesion is small.

17. Laryngo-esophageal cleft.
It is due to failure of the fusion of cricoid
lamina.
Very rare
Patient presents with repeated aspiration
and pneumonitis. Coughing, choking and
cyanosis are present at the time of feeding.

18. Laryngeal cyst
It arises in the aryepiglottic fold.
appears as bluish, fluid-filled smooth swelling in the
supraglottic larynx.
Hoarseness is the most common presenting symptom.
They may cause significant respiratory obstruction leading
to dyspnea or respiratory distress
 Respiratory obstruction may necessitate tracheostomy.
Treatment is deroofing the cyst or excision with CO2 laser