Glottic web

Last revised by Henry Knipe on 18 Feb 2023

Glottic webs are focal narrowings of the airway due to the formation of a membranous connection at the level of the true vocal folds 1.

Symptoms include exercise intolerance, dysphonia, hoarseness, stridor, respiratory distress and airway obstruction7.

Infants may also present with a weak or high-pitched cry, feeding difficulties, failure to thrive, apnea and cyanosis5.

Generally, anterior glottic webs make intubation difficult or impossible 8.

Webs vary in size and thickness and usually involve the anterior glottis extending inferiorly 6.  

Most commonly glottic webs are acquired and may occur at any age 2.

Acquired lesions should be further investigated as causes include:

  • trauma close to the anterior commissure by endotracheal intubation, surgery, laser therapy and radiotherapy 3

  • inflammation, e.g. gastro-esophageal reflux disease 1

  • infection, e.g. Corynebacterium diphtheriae, Bacillus cereus 4

  • autoimmune disease, e.g. Crohn disease, pemphigoid, and plasmacytosis infiltrates 4

Congenital glottic webs are uncommon and are thought to result from disrupted laryngeal embryogenesis, specifically the failure of epithelial layer resorption at the laryngotracheal groove5.

Congenital anterior glottic webs are associated with various syndromes, particularly 22q11.2 deletion syndrome and therefore require further investigations 5.

Acquired anterior glottic webs are associated with recurrent tracheobronchitis, recurrent pneumonia and vocal fold scarring 2. Laryngeal framework stenosis are also associated and can be either supraglottic, glottic - due to thyroid cartilage constriction - or subglottic - due to cricoid cartilage deformity 9.

Although CT and virtual endoscopy can provide useful information aiding diagnosis and extension, anterior glottic webs are best evaluated by awake flexible laryngoscopy and, if necessary, a direct laryngoscopy or bronchoscopy 10.

CT may show a blunting of the normally sharp angle between the vocal folds and a reduction in the size of the glottic opening 8.

A wide variety of open and endoscopic surgical procedures have been proposed depending on symptom severity and the anatomical extension of the anterior glottic web 7.

Treatment aims to relieve airway obstruction and provide a functional voice. However, anterior glottic web tend to reform following treatment 1.

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