Unsuspected subglottic web in a child managed for severe respiratory obstruction

Subglottic stenosis is a known complication of a traumatic and prolonged intubation. In a child, subglottic area is narrower and more prone to damage by an oversized or overinflated endotracheal tube. The stenosis can present with complaints of change in voice, croup, or respiratory obstruction. Those presenting with respiratory obstruction require immediate diagnosis under direct laryngoscopy and timely corrective intervention under general anesthesia. A 4-year-old child came to the emergency department with severe respiratory obstruction. His medical history revealed invasive ventilatory management for aspiration pneumonitis 2 months back. Under direct laryngoscopy, we found severe narrowing of the subglottic area due to subglottic web. Since the subglottic area was so stenosed, intubation was impossible. Hence, emergency tracheostomy was performed to secure patient airway, followed by microlaryngeal surgery to remove the subglottic web. Acquired subglottic stenosis in a child can be a life-threatening situation which requires immediate airway management. It should be suspected in any child in severe respiratory obstruction with a history of prolonged intubation.