Congenital Pharyngeal Web in an Adult: Treatment of a Rare Clinical Anomaly by Coblation

Abstract

Previous reports of congenital pharyngeal webs, although rare, have been described in children. Clinical presentation varies, ranging from aspiration to intermittent airway obstruction, and most commonly, dysphagia. In this case report, the authors describe an unusual finding of a hypopharyngeal web in an adult patient. This patient had no prior history of chemoradiotherapy, malignancy, or total laryngectomy, all of which have been associated with acquired pharyngeal stenosis, supporting that this finding was of congenital origin. After a review of the possible embryological developmental abnormalities, the hypothesis is that of gut recanalization failure during development. CASE PRESENTATION CASE PRESENTATION We present a case of a woman in her mid-40's with a history of solid food dysphagia resulting in a 20 kg weight loss over three months. The patient denied dysphagia progressing to liquids, pain with swallowing, and a history of alcohol or tobacco use. Upon examination of the larynx via laryngoscope, a congenital hypopharyngeal web was identified. Successful excision of the web via coblation restored proper drainage of the pyriform sinus into the esophagus and resulted in markedly improved swallowing function and weight gain. CONCLUSIONS CONCLUSIONS Pharyngeal webs are rare findings, particularly in adult patients. These congenital anomalies can be safely and effectively treated endoscopically via coblation.

A rare case of congenital adult pharyngeal web causing airway obstruction managed by coblation technology

“…The author used coblation technology for the clean excision of the hypopharyngeal web. 13 An elderly woman, a known case of Behcet's disease, was diagnosed to have pharyngeal webs, and she had been treated for many years with esophageal dilations for an upper esophageal web. The cause remained unclear and could be of acquired origin.…”

“…For example: CO2 laser excision via direct laryngoscopy balloon dilatation of webs and coblation-assisted removal. 4,2,13,14 The coblation technique has the advantages of less post-operative pain, less blood loss, and clear excision of mucosal tissues. When intubation through the glottis is not possible, an awake tracheostomy can be done in a patient under local anesthesia without sedation.…”

“…In a previously reported case by Katrina et al they used coblation for the first time for the removal of the hypopharyngeal web. 13 This case describes the approach and management of an incidentally discovered congenital pharyngeal web in an adult patient and the importance of proper airway prediction preoperatively to prevent difficult airway situations.…”