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.