# Unanticipated Difficult Airway in a Child With an Undiagnosed Subglottic Laryngeal Web: Caught in the Web, Saved by a Nick

## TL;DR

A child with an undiagnosed laryngeal web faced unexpected airway difficulties during anesthesia, requiring careful management to avoid complications.

## Contribution

This case highlights the challenges of managing unanticipated difficult airways in children with subglottic laryngeal webs.

## Key findings

- Laryngeal webs can cause significant anesthetic challenges in pediatric patients.
- Unanticipated difficult intubation in children can be life-threatening due to small airways and rapid desaturation.
- Early recognition and appropriate airway management are critical in such cases.

## Abstract

Laryngeal webs are abnormal tissue formations within the larynx, typically caused by incomplete recanalization during embryonic development of the larynx at 8-10 weeks of gestation. They result from incomplete resorption of the epithelial layer that normally obliterates the developing laryngeal opening, leading to the formation of a web. Congenital laryngeal webs are rare, with an estimated incidence of approximately 1 in 10,000 births, accounting for about 5% of all congenital laryngeal anomalies. They are associated with significant anesthetic challenges, such as difficulty in intubation or the need for invasive airway access. In pediatric patients, this is further complicated by a smaller airway diameter, lower oxygen reserves, and faster desaturation, which can quickly turn an unanticipated airway difficulty into a critical situation. Here, we present the airway management of a child with unanticipated difficult intubation secondary to an undiagnosed subglottic web.