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Congenital laryngeal lesions

Kelainan Kongenital Pada Laring

Signs of this condition show themselves shortly after birth with inspiratory stridor and feeding difficulties. When breathing in, these babies experience an excessive collapse and indrawing of the supraglottic airways, leading to breathing difficulties. Usually this condition is mild and self limiting. When it is severe an aryepiglottoplasty may be performed. This involves dividing the excessively tight aryepiglottic folds, which allows the epiglottis to spring upwards and open up the airway. 

Subglottic stenosis 
This abnormality is caused by an excessively narrow cricoid cartilage. It is either a birth defect, or it arises as a result of intubation and prolonged ventilation. Subglottic cysts and haemangiomas may present with similar symptoms. The main sign of this condition is stridor at any age from birth to 2 years. Diagnosis is made by inspecting and measuring the diameter of the subglottis under general anaesthetic. Mild cases may be treated conservatively, but more severe stenoses require surgical invervention and laryngo-tracheal reconstruction.

Laryngeal web 
This condition occurs when the vocal cords fuse together and the airway is reduced. Fusion can be minimal, with little effect on the airway; or complete fusion can occur which is incompatible with life. The main signs of this condition are respiratory difficulties, stridor and a hoarse cry. Severe cases will require immediate surgical intervention either via a tracheostomy (when an artificial breathing hole is made in the neck below the cords to bypass the obstruction) or by endoscopic division of the web. 

Laryngeal cleft 
This condition occurs when the posterior larynx has failed to fuse. At its most severe this will also extend down to involve the posterior wall of the trachea. The main signs are respiratory problems associated with feeding, as a result of aspiration into the trachea. Mild cases can be difficult to diagnose. Where there are symptoms, surgical repair may be needed. 

Vocal cord palsy 
The recurrent laryngeal nerves are long in children and adults, reaching from the skull base down into the chest and back up again to the larynx. Because of their length, they are prone to damage anywhere along their course. Unilateral palsy will cause a weak breathy cry and feeding difficulties as a result of aspiration, and bilateral palsy will present as marked stridor. 

Referensi: Oxford Handbook of ENT and Head and Neck Surgery by Rogan Corbridge (Oxford University Press) 2006

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