Anterior glottic web

Discussion:

Acquired anterior glottic webs are the most common type of glottic web. They are commonly due to traumatic injury to the larynx from either intubation, laryngeal surgery, external trauma or infection.  They can range from small microwebs to those involving the entire length of the membranous vocal fold. Symptoms will depend on the extent of the web 1,2

A number of conditions are associated with anterior glottic webs namely laryngeal framework stenosis. This may be either supraglottic stenosis, thyroid cartilage constriction resulting in glottic stenosis and/or subglottic stenosis resulting from cricoid cartilage deformity. The differential diagnosis for anterior glottic webs includes; sarcoidosis, granulomatosis with polyangiitis, and amyloidosis 1

In this case, previous trauma to the larynx during difficult intubation two years prior is the likely cause for the patient's glottic web and subglottic stenosis. 

This case highlights that subtle but potentially life-threatening laryngeal pathology may be difficult to identify on radiology. All patients with stridor warrant prompt ENT referral for indirect laryngoscopy to identify pathology and instigate appropriate airway management. 

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