Neonatal airway emergency: congenital laryngeal myxoma

Laryngeal myxomas are exceptionally rare benign mesenchymal tumors, particularly in the pediatric population. We present a case of a neonate with a history of brief endotracheal intubation who developed inspiratory stridor and respiratory distress. Flexible laryngoscopy revealed a pedunculated mass on the right true vocal cord. The lesion was completely excised via microlaryngobronchoscopy. Definitive histopathological and immunohistochemical analysis-showing a hypocellular myxoid stroma, bland spindle cells, a low Ki-67 proliferation index (<5%), and positivity for CD34 with negative staining for S-100, desmin, smooth muscle actin, myogenin, ALK1, and β-catenin-confirmed the diagnosis of a congenital laryngeal myxoma, differentiating it from a reactive post-intubation granuloma. This case highlights the importance of definitive histopathological diagnosis over presumptive clinical history and emphasizes the inclusion of rare congenital neoplasms in the differential diagnosis of neonatal stridor. Complete surgical excision is the treatment of choice.