The document discusses various congenital lesions of the larynx that can cause stridor in infants and children, including laryngomalacia, vocal fold paralysis, subglottic stenosis, laryngeal web, and subglottic hemangioma. It describes the clinical presentation, diagnosis, and treatment of each condition. The document also covers acquired causes of stridor and outlines the approach to evaluating and managing a child presenting with stridor.

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