Microlaryngoscopic Management of a Congenital Laryngeal Web in a Young Adult Female

Congenital laryngeal webs (CLW) are rare anomalies that result from failed recanalization of the larynx, resulting in abnormal tissue that can cause dysphonia, hoarseness, or stridor. Although the vast majority of cases are diagnosed and managed operatively before early childhood, we report a rare case of an adult laryngeal web in a 20-year-old female who presented with a lifelong whisper-like voice and difficulty breathing with exertion. Visualization with flexible laryngoscopy revealed a high-grade CLW extending from the anterior commissure to the vocal process of the arytenoids bilaterally, resulting in limited vocal cord abduction. Despite standard recommendations for open airway surgery, the patient was selected to undergo microlaryngoscopic cold steel division of the glottic web with topical mitomycin C application to reduce scar formation and potential further voice and breathing impairment. Following a successful operation and postoperative speech therapy, the patient had markedly improved phonation and breathing. The present work is the first documented case of a high-grade adult CLW managed endoscopically with cold steel lysis and mitomycin C application, demonstrating these patients may achieve significant functional improvement using this approach while avoiding the morbidity of open approaches.