Laryngeal web: A cause of difficult endotracheal intubation

Two cases illustrate that asymptomatic laryngeal webs or scars may be an occasional cause of difficult endotracheal intubation. Furthermore, these cases suggest that fiberoptic nasopharyngoscopy should be considered in all difficult intubations if no apparent cause is present and exposure of the larynx is difficult. Flow volume loops may not be sensitive in the detection of laryngotracheal lesions; tomograms may also be negative if the lesions are thin and if they do not alter the diameter of the trachea or subglottis. It is important to maintain vigilance and gentleness in attempting difficult endotracheal intubations; inadvertent rupture of a laryngeal web or scar could lead to recurrence, and possibly formation, of a symptomatic occlusive scar.