Abstract
Objective: The literature on the entity of the anterior larynx (AL) is
restricted to little evidence on the difficulty encountered in exposing
the larynx for intubation, perioperative morbidity and mortality, and
scant reports on its prevalence in general adults and children. We here
describe the prevalence of AL in a series of children presenting with
aerodigestive symptoms and explore its association with functional
abnormalities, congenital and structural anomalies or conditions.
Setting: Tertiary pediatric center Methods: we conducted a retrospective
case-control study. Using a prospectively collected surgical database we
identified patients diagnosed with AL (grades IIb-III-IV Modified
Cormack-Lehane scale) and sex and age-matched controls who had undergone
full airway endoscopy for aerodigestive symptoms. We collected the
demographics, presentations, associated diagnoses, and investigations.
We compared the proportion of patients with large airway abnormalities
and dysmorphism and estimated the prevalence of AL. Results: over a
5.5-year period, 58 children (28 females) were matched with 58 controls.
Although both groups presented with permutations of stridor, respiratory
failure, cyanotic spells, swallowing and feeding difficulties and SDB,
AL presented much more with swallowing and feeding problems (33 vs 20,
p<0.05). There were significantly more children with
dysmorphism in the AL group (29 vs 9, P < 0.05). The
prevalence of AL was 4.9%. Conclusions: This is the first study to
report the prevalence of AL amongst a cohort of children with
aerodigestive symptoms. Its significant association with dysmorphic
features warrants genetic consultation. It is associated with swallowing
abnormalities that justifies a systematic instrumental evaluation