Results and Conciusion
All cases were followed up for over 2 years. We found that three
children with type I and II laryngeal web had recovered through a single
endoscopic procedure, and their hoarseness was relieved after the
surgery. Seven children with type III and IV laryngeal web had their
cervical tracheal tubes successfully removed. As a result, these
children did not resume dyspnea during the follow-up period, but some
children were still presented with hoarseness.
Children
with type I and II laryngeal web were mainly presented with hoarseness
and discomfort without any obvious respiratory distress(P<0.05).
Children were usually older when they were presented to the
hospital(p<0.05), and it was usually identified when their
families found out that their voices had been hoarse for a long time.
The patients with laryngeal web recovered through a simple endoscopic
surgery(p<0.05). However, children with type III and IV
laryngeal web mainly exhibited hoarseness and respiratory distress,
which required an early tracheotomy. The most common comorbidity of
laryngeal web type III and IV was subglottic stenosis, which was
probably combined with other laryngeal diseases such as vocal cord
paralysis and laryngomalacia along with systemic diseases such as atrial
septal defect. Children with laryngeal web type III and IV usually had a
record of multiple visits to the hospital with multiple
treatments(p<0.05). The ultimate treatment required for such
patients was open laryngoplasty and We suggest that these children
should receive open laryngoplasty at around 2 years of age. The T-tube
implantation is effective in preventing the re-adhesion of the vocal
cords. However, it may cause discomfort, such as choking and coughing
early on after the surgery. Thus, such patients need to be given a soft
or semi-liquid diet. The recommended duration for the T-tube implant is
6 months. In children with subglottic stenosis, the lingual bone or
autologous rib cartilage can be used simultaneously to reconstruct the
cricoid cartilage. We recommend using the hyoid bone for reconstruction
as it can be obtained in the same surgical area, reducing unnecessary
trauma. Simultaneously, an open laryngoplasty can be performed for
children having a combination of vocal cord paralysis. Open
laryngoplasty can resolve the child’s breathing difficulties and help in
the successful removal of the cervical tracheal tube. We have advanced
the age of surgery to 1 year old, shortening the time for tracheostomy
to open the tube, greatly improving the quality of life of the children,
and reducing the nursing burden and living burden of the children’s
families. However, the child may still have postoperative
hoarseness, which may require
further rehabilitation.