1. CONGENITAL LESIONS OF
LARYNX AND STRIDOR
DEPT OF OTORHINOLARYNGOLOGY
JJM M C
DAVANAGERE

2. LARYNGOMALACIA
• Most common congenital abnormality of larynx
• Condition manifests at birth or soon after and
usually disappears by two years of age
• Characterized by excessive flaccidity of
Supraglottic larynx which is sucked in during
inspiration producing stridor and cyanosis
• Stridor subsides on placing child in prone position
and increases with crying
• Direct laryngoscopy elongated and curled up
epiglottis (omega shaped), floppy AE folds and
prominent arytenoids
• Treatment is conservative
• In severe stridor tracheostomy

4. CONGENITAL VOCAL FOLD
PARALYSIS
• Results from birth trauma when
RLN is stretched during breach or
forceps delivery
• Can also results from anomalies of
CNS

5. CONGENITAL SUBGLOTTIC
STENOSIS
• Due to abnormal thickening of cricoid
cartilage or fibrous tissue seen below
the vocal cords
• Child may remain asymptomatic till
URTI causes dyspnoea and stridor
• Diagnosis subglottic diameter less
than 4mm in full term neonate (normal
4.5-5.5mm) or 3mm in premature
neonate (normal 3.5mm)
• Most cases improve as larynx grows but
some may require surgery

7. LARYNGEAL WEB
• Due to incomplete recanalization of
larynx
• Seen between the vocal cords with
concave posterior margin
• Presents as airway obstruction, weak
cry or aphonia dating from birth
• Treatment depends on thickness of web
• Thin web cut with knife or CO2 laser
• Thick web excision via laryngofissure
and placement of silicone keel and
subsequent dilatation

9. SUBGLOTTIC HAEMANGIOMA
• Though congenital patient is asymptomatic till 3-6 months
of age
• About 50% have associated cutaneous haemangioma
• May present with stridor which increases on agitation and
crying due to venous filling
• Direct laryngoscopy shows reddish blue mass below
vocal cords
• Biopsy is sometimes, not always associated with
hemorrhage
• Treatment depends on individual case
 Tracheostomy and observation
 Steroid therapy
 CO2 laser excision

10. SUBGLOTTIC
HAEMANGIOMA

11. 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

12. LARYNGEAL CYST
• Arises in the AE folds and appears as
bluish fluid filled smooth swelling in
Supraglottic larynx
• Respiratory obstruction tracheostomy
• Needle aspiration or incision and
drainage provides emergency airway
• Treatment is deroofing the cyst or
excision with CO2 laser

14. STRIDOR
• Defined as noisy respiration
produced by turbulent airflow
through narrowed air passage
• Classified as Inspiratory, expiratory
and biphasic

15. STRIDOR
• Inspiratory stridor produced in
obstructive lesion of Supraglottic or
pharynx
• Expiratory stridor lesions of
thoracic trachea, primary and
secondary bronchi
• Biphasic lesions of glottis,
subglottis and cervical trachea

16. STRIDOR
• CONGENITAL • AQUIRED
 LARYNGOMALACIA
1. FEBRILE
 EPIGLOTITTIS
 LARYNGEAL WEB
 LARYNGO-TRACHEITIS
 DIPHTHERIA
 SUBGLOTTIC STENOSIS
 INFECTIOUS
MONONUCLEOSUS
 HAEMANGIOMA  RETROPHARYNGEAL
ABSCESS
 VOCAL CORD PARALYSIS  QUINSY
 TONGUE AND JAW 2. AFEBRILE
ABNORMALITIES  PAPILLOMATOSIS
 FOREIGN BODY
 LARYNGEAL OEDEMA
 ADENO TONSILLAR
HYPERTROPHY

17. STRIDOR-CAUSES
• Nose: choanal atresia in newborn
• Tongue: macroglossia, haemangioma,
lymphangioma, lingual thyroid
• Mandible: micrognathia, Pierre-Robin syndrome
• Pharynx: congenital dermoid, retropharyngeal
abscess, tumors, adenotonsillar hypertrophy
• 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

18. STRIDOR-CAUSES
• Trachea and bronchi:
 Congenital: atresia, stenosis, malacia
 Inflammatory: tracheobronchitis
 Neoplastic: tumors
 Traumatic: foreign body and stenosis
• Lesions 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

19. STRIDOR-MANAGEMENT
• History: onset, progression, duration,
relation to feeding, cyanotic spell,
aspiration or ingestion of foreign body,
laryngeal trauma
• Physical examination: signs of
respiratory distress, stridor with phase
of respiration, associated features like
fever, wheeze, snoring, hoarseness,
muffled voice

20. STRIDOR-MANAGEMENT
• Investigations
 X-ray chest and soft tissue neck AP and
lateral view
 Fluoroscopy
 CT of neck and chest
 Oesophagogram
 Angiography
 Xeroradiography
 Direct laryngoscopy
 Pan endoscopy

21. STRIDOR-MANAGEMENT
• Treatment: treat the exact cause
depending on the diagnosis