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<p>Congenital high-grade glottic webs with subglottic extension are rare, representing &lt; 5% of congenital laryngeal lesions. Laryngotracheal reconstruction (LTR) with anterior grafting and stenting is a well-established management. Decannulation failure after laryngotracheal reconstruction (LTR) is uncommon, especially when the reconstructed airway appears anatomically patent.&#xa0;We report a full-term male infant with a congenital grade III glottic web with subglottic extension. A tracheostomy was performed at one month of age. At nine months, he underwent open LTR. Despite a widely patent airway on laryngoscopy, two decannulation attempts failed. Drug-induced sleep endoscopy (DISE) revealed dynamic complete epiglottic collapse. Supraglottoplasty was performed using coblation. Two weeks later, decannulation was successful. At three-month follow-up, the child had normal feeding, a strong voice, and no respiratory symptoms. Dynamic airway collapse should be considered in cases of unexpected decannulation failure after LTR. DISE is essential for identifying occult supraglottic obstruction, and targeted supraglottoplasty can facilitate successful decannulation.</p>

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Epiglottic Collapse as an Unrecognized Cause of Decannulation Failure After Laryngotracheal Reconstruction in an Infant: A Case Report

  • 期刊论文

  • 发表日期：

    2026年2月17日

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  • Ahmed Abdel-Fattah ElSobki,
  • Eslam Hamed Abdou

摘要

Congenital high-grade glottic webs with subglottic extension are rare, representing < 5% of congenital laryngeal lesions. Laryngotracheal reconstruction (LTR) with anterior grafting and stenting is a well-established management. Decannulation failure after laryngotracheal reconstruction (LTR) is uncommon, especially when the reconstructed airway appears anatomically patent. We report a full-term male infant with a congenital grade III glottic web with subglottic extension. A tracheostomy was performed at one month of age. At nine months, he underwent open LTR. Despite a widely patent airway on laryngoscopy, two decannulation attempts failed. Drug-induced sleep endoscopy (DISE) revealed dynamic complete epiglottic collapse. Supraglottoplasty was performed using coblation. Two weeks later, decannulation was successful. At three-month follow-up, the child had normal feeding, a strong voice, and no respiratory symptoms. Dynamic airway collapse should be considered in cases of unexpected decannulation failure after LTR. DISE is essential for identifying occult supraglottic obstruction, and targeted supraglottoplasty can facilitate successful decannulation.