Key words Dyspnea in children · Laryngeal web · Laryngeal
mask
Sirs: Development of the laryngeal mask airway (LMA) was
first described in 1981 by Dr. Archie Brain, a British anesthesi-
ologist [6]. Constructed entirely of soft, medical-grade silicone
rubber to withstand repeated autoclaving, the LMA consists of a
tube or shaft that is fused at a 30˚ angle to a distal elliptical
spoon-shaped mask with an inflatable rim, resembling a minia-
ture face mask. Recently, it was modified to be flexible and re-
inforced. The LMA can be inserted blindly and is advanced in
one smooth movement until a characteristic resistance is felt as
the upper esophageal sphincter is engaged. It offers less irrita-
tion to the throat than a tracheal tube, does not require muscle
relaxants or the use of a laryngoscope, is better tolerated than a
tracheal tube, can be used in the management of difficult intuba-
tions and emergency resuscitation, and can be employed for
both controlled and spontaneous ventilation [6].
Laryngeal webs, subglottic stenosis, and congenital laryn-
geal atresia result from the failure of resorption of proliferating
epithelium in the laryngeal lumen during embryological devel-
opment [4]. The cause of a congenital laryngeal web is still un-
known, but familial cases have been reported [2]. In several, la-
ryngeal webs constitute about 3% of all congenital anomalies of
the larynx, and their incidence has been estimated at approxi-
mately 1 in 10,000 births [3].
The major clinical features of laryngeal webs are abnormal-
ity of the voice, respiratory distress and stridor, although certain
cases may be asymptomatic [2, 4]. Respiratory distress includes
cyanosis at birth or unexplained airway obstruction, both of
which may require either immediate intubation or a tracheotomy
[2]. Recurrent or atypical croup can occur in some patients.
We have now diagnosed a laryngeal web in a patient by us-
ing the laryngeal mask and suggest its use in the evaluation of
childhood stridor and laryngeal web.
A 6-year-old Turkish girl was brought to Yüzüncü Yıl Uni-
versity for evaluation of a husky voice. She also had breathing
difficulty and mild cyanosis with exercise present since early
childhood. She had no prior history of surgery or trauma and
no systemic anomalies were known. Awake examination of the
larynx was not possible due to the patient’s irritability, so she
H. Çankaya · I
˙
. Katı · E. Egeli · C. B. Demirel
Use of the laryngeal mask to evaluate a laryngeal web
Eur Arch Otorhinolaryngol (1999) 256 : 523–524 © Springer-Verlag 1999
Received: 6 October 1998 / Accepted: 22 January 1999
LETTER TO THE EDITORS
H. Çankaya (Y) · E. Egeli
University of Yüzüncü Yıl, School of Medicine,
Department of Otorhinolaryngology,
Head and Neck Surgery, TR-65300
I
˙
. Katı · C.B. Demirel
University of Yüzüncü Yıl, School of Medicine,
Department of Anesthesiology and Reanimation, Van, Turkey
Fig. 1 Intraoperative position of the patient. Endoscope was
passed through the LMA tube