Laryngomalacia, Congenital Vocal Fold Paralysis, Congenital Subglottic Stenosis, Laryngeal Web, Subglottic Haemangioma, Laryngo-Oesophageal Cleft, Laryngeal Cyst, Stridor, Pierre-Robin Syndrome, Laryngeal Papillomatous, Stridor-Causes, Laryngeal Atresia, Pakistan

1. Brig Anwar ul Haq
ENTSpecialist
CMH Lahore

3. Brig Anwar ul Haq
ENTSpecialist
CMH Lahore

4. Congenital lesions of larynx
Laryngomalacia (Congenital Laryngeal Stridor)
Congenital Vocal Cord Paralysis
Congenital Subglottic Stenosis
Laryngeal Web
Subglottic Haemangioma
Laryngo-oesophageal Cleft
Laryngocele
Laryngeal Cyst

5. Laryngomalacia
Most common congenital abnormality of
larynx
Manifests
Birth
Soon after and
Disappears by two years of age
Characterized
Excessive flaccidity of supraglottic larynx
Larynx ix sucked in during inspiration
Stridor and cyanosis

6. Laryngomalacia
Stridor subsides in prone position
 Stridor increases with crying

7. Laryngomalacia
Direct laryngoscopy
Elongated and curled up epiglottis (omega shaped)
Floppy AE folds
Prominent arytenoids

8. Laryngomalacia
Treatment
Conservative
Usually
Tracheostomy
Severe stridor

9. Congenital Vocal Fold Paralysis
Birth trauma
RLN is stretched during breach or
forceps delivery
Anomalies of CNS

10. Congenital Subglottic Stenosis
Abnormal thickening of cricoid
cartilage
Fibrous tissue seen below the vocal
cords

11. Congenital Subglottic Stenosis
Asymptomatic
Dyspnoea - URTI
Stridor - URTI

12. Congenital Subglottic Stenosis
Diagnosis
Subglottic diameter
<4mm in full term neonate
 Normal 4.5-5.5mm
<3mm in premature neonate
 Normal 3.5mm
 Spontaneous improvement
 as larynx grows
oSurgery
only some patients

13. Laryngeal Web
Incomplete recanalization of larynx
Seen between the vocal cords with
concave posterior margin

14. Laryngeal Web
Symptoms
Airway obstruction
Dysponea
Stridor
Weak Cry
Aphonia dating from birth

15. Laryngeal Web
Treatment depends on thickness of web
Thin web
Cut with knife
Cut with CO2 laser
Thick web
Excision via laryngofissure
Placement of silicone keel
Subsequent dilatation

16. Subglottic Haemangioma
Asymptomatic till 3-6 months of age
50% have associated cutaneous haemangioma
Presentation
Stridor which increases on agitation
Stridor on crying due to venous filling

17. Subglottic Haemangioma
Direct laryngoscopy
Reddish blue mass below vocal cords
Biopsy is sometimes, not always associated with
hemorrhage

18. Subglottic Haemangioma
Treatment depends on individual case
Observation
Tracheostomy
Steroid therapy
Dexamethasone 1 mg/kg/day for 1 week
Then prednisolone 3 mg/kg in divided
doses for one year.
Co2 laser excision

19. Laryngo-Oesophageal Cleft
Due to failure of fusion of cricoid lamina
Presents with repeated aspiration and
pneumonitis
Coughing, choking and cyanosis are present
at the time of feeding
Surgically treated

20. Laryngeal Cyst
Site - AE folds
Appearance as bluish fluid filled
smooth swelling in supraglottic
larynx
Respiratory obstruction
Stridor
Dysponea

21. Laryngeal Cyst
Treatment
Tracheostomy
Needle aspiration
Incision and drainage
Treatment is de roofing the cyst
Excision with CO2 laser

22. Stridor
Defined as noisy respiration produced
by turbulent airflow through narrowed
air passage
Classified as
Inspiratory
Expiratory
Biphasic

24. Stridor
Inspiratory stridor
Produced in obstructive lesion of supraglottic or
pharynx
Expiratory stridor
Lesions of thoracic
 Trachea
 Primary brocnhi
 Secondary bronchi
Biphasic
Lesions of glottis
Subglottis
Cervical trachea

25. Stridor
Congenital
Laryngomalacia
Laryngeal web
Subglottic stenosis
Haemangioma
Vocal cord paralysis
Tongue and jaw
abnormalities
Aquired
1. Febrile
 Epiglotittis
 Laryngo-tracheitis
 Diphtheria
 Infectious mononucleosus
 Retropharyngeal abscess
 Quinsy
2. Afebrile
 Papillomatosis
 Foreign body
 Laryngeal oedema
 Adeno tonsillar
hypertrophy

27. Stridor-Causes (accordig to the site)
Nose
 Choanal atresia in newborn
Tongue
 Macroglossia,
 Haemangioma
 Lymphangioma
 Lingual thyroid
Mandible
 Micrognathia
 Pierre-robin syndrome
Pharynx
 Congenital dermoid
 Retropharyngeal abscess
 Tumours
 Adenotonsillar hypertrophy

28. Stridor-causes - Larynx
Congenital
Web
Laryngomalacia
Cyst
Subglottic stenosis
Inflammatory
 Epiglottitis
 Laryngotracheitis
 Diphtheria
Neoplastic
 Haemangioma
 Juvenile papilloma
 Carcinoma in adults
Traumatic:
• Injuries to larynx
• Foreign bodies
• Prolonged intubation
Neurogenic:
• Laryngeal paralysis
Miscellaneous:
• Tetanus
• Tetany
• Laryngismus stridulus

29. Pierre-Robin Syndrome
PRS
Charactriscts
 Cleft palate
Retrognathia(abnormal positioning of the jaw
or maxilla)
Glossoptosis
Downward displacement
Retraction of the tongue

30. Laryngeal Papillomatous

31. Laryngeal Papillomatous

32. Stridor-Causes- Trachea and bronchi
Congenital
 Atresia
 Stenosis
 Tracheomalacia
Inflammatory
 Tracheobronchitis
Neoplastic
 Tumors
Traumatic
 Foreign body
 Stenosis

33. Stridor- Causes Outside Respiratory Tract
Congenital
 Vascular rings
 Oesophageal atresia
 Tracheo-oesophageal fistula
 Cystic hygroma
Inflammatory
 Retroeosophageal abscess
Traumatic
 Foreign body oesophagus
Tumors
 Masses in the neck

34. Laryngeal Atresia

35. Stridor- Causes Outside Respiratory Tract
Congenital
 Vascular rings
 Oesophageal atresia
 Tracheo-oesophageal fistula
 Cystic hygroma
Inflammatory
 Retroeosophageal abscess
Traumatic
 Foreign body oesophagus
Tumors
 Masses in the neck

36. Stridor- Causes Outside Respiratory Tract
Congenital
 Vascular rings
 Oesophageal atresia
 Tracheo-oesophageal fistula
 Cystic hygroma
Inflammatory
 Retroeosophageal abscess
Traumatic
 Foreign body oesophagus
Tumors
 Masses in the neck

37. Stridor-Management
History:
Onset
Progression
Duration
Relation to feeding
Cyanotic spell
Aspiration or ingestion of foreign body
Laryngeal trauma

38. Stridor-Management
Physical Examination
Signs of respiratory distress
Stridor with phase of respiration
Associated features
 Fever
 Wheeze
 Snoring
 Hoarseness
 Muffled voice

39. Stridor-Management
Investigations
X-ray chest
X Ray soft tissue neck AP and lateral
view
Fluoroscopy
CT of neck and chest
Oesophagogram
Angiography
Xeroradiography

40. Stridor-Management
Investigations
X-ray chest
X Ray soft tissue neck AP and lateral
view
Fluoroscopy (Radiological Examination)
CT of neck and chest
Oesophagogram / Ba Swallow
Angiography
Xeroradiography

41. Stridor-Management
Investigations
X-ray chest
X Ray soft tissue neck AP and lateral
view
Fluoroscopy
CT of neck and chest
Oesophagogram
Angiography
Xeroradiography

42. Stridor-Management
Examination of Nose
Examination of Pharynx
Direct laryngoscopy
Pan endoscopy

43. Stridor-management
Treat the exact cause
Depending on
Diagnosis

44. ?