Endoscopic Repair of Congenital Airway Anomalies

Introduction

Congenital anomalies of the airway are structural abnormalities present at birth that may affect the larynx, trachea, or bronchi. These conditions can range from mild breathing difficulty to life-threatening airway obstruction. In recent decades, endoscopic techniques have transformed the management of these anomalies by offering minimally invasive repair with excellent visualization and minimal trauma.

Common Congenital Airway Anomalies

Laryngomalacia – Collapse of supraglottic structures during inspiration
Subglottic stenosis – Narrowing of the airway below the vocal cords
Tracheomalacia – Weakness of the tracheal walls causing collapse
Laryngeal webs – Thin membranes that partially block the larynx
Glottic or subglottic cysts
Congenital vocal cord paralysis
Tracheoesophageal fistula (TEF) – Abnormal connection between trachea and esophagus (selected cases treated endoscopically)

Indications for Endoscopic Airway Surgery

Respiratory distress or noisy breathing (stridor)
Failure to thrive due to feeding-breathing coordination issues
Recurrent respiratory infections
Difficulty weaning from ventilation
Confirmed airway obstruction on endoscopy or imaging

Benefits of Endoscopic Approach

Avoids external neck incisions
Reduced tissue trauma and scarring
Magnified, illuminated view of delicate airway structures
Shorter recovery time
Can be repeated or combined with other procedures if needed

Surgical Techniques Used

1. Supraglottoplasty

Most commonly performed for laryngomalacia
Laser or cold instruments are used to trim excess tissue (aryepiglottic folds, epiglottis)

2. Endoscopic Balloon Dilation

Used for subglottic or tracheal stenosis
A high-pressure balloon gently widens the narrowed airway segment

3. Endoscopic Lysis of Webs or Cysts

Thin membranes or cysts are incised using microinstruments or laser
May require stenting or follow-up dilation

4. Injection Laryngoplasty or Botox

In selected vocal cord paralysis cases to improve voice and airway protection

5. Endoscopic Fistula Closure

Certain small tracheoesophageal fistulas can be treated using laser or cautery

Postoperative Management

Observation in a pediatric ICU if airway swelling is anticipated
Nebulized steroids and humidified oxygen
Voice rest or feeding support depending on the procedure
Repeat endoscopy in selected cases to assess healing or recurrence

Complications (Rare)

Bleeding
Infection
Airway edema or obstruction
Granulation tissue formation
Need for revision procedure
Subglottic scarring (in stenosis cases)

Long-Term Outcomes

Most children undergoing endoscopic airway surgery show significant improvement in breathing, feeding, and voice.
In complex or recurrent cases, staged procedures may be necessary.
Compared to open surgery, endoscopy provides faster healing and preserves airway anatomy better in many cases.