ABSTRACT
Congenital airway malformations encompass a broad array of disorders that occur at diverse anatomic levels. This chapter presents an overview of congenital anomalies extending from the larynx to the distal airway. It describes patient assessment, symptomatology, and contemporary management strategies. Mild airway compromise may manifest with subtle symptoms such as irritability, restlessness, and feeding difficulties. The most critical component of the airway assessment is endoscopy. This may include three endoscopic procedures performed consecutively with the patient under a single anesthesia: flexible bronchoscopy with bronchoalveolar lavage (BAL); microlaryngoscopy and rigid bronchoscopy; and esophagoduodenoscopy with biopsy. Laryngomalacia is the most common congenital laryngeal anomaly and is also the most common cause of stridor in neonates. Laryngeal webs result from a failure of recanalization of the glottic airway in early weeks of embryogenesis. Children with acquired vocal cord paralysis may experience spontaneous recovery several months after nerve injury; however, this occurs only if the nerve is stretched or crushed but is otherwise intact.
