Unanticipated Difficult Airway in a Child With an Undiagnosed Subglottic Laryngeal Web: Caught in the Web, Saved by a Nick

Laryngeal webs are abnormal tissue formations within the larynx, typically caused by incomplete recanalization during embryonic development of the larynx at 8-10 weeks of gestation. They result from incomplete resorption of the epithelial layer that normally obliterates the developing laryngeal opening, leading to the formation of a web. Congenital laryngeal webs are rare, with an estimated incidence of approximately 1 in 10,000 births, accounting for about 5% of all congenital laryngeal anomalies. They are associated with significant anesthetic challenges, such as difficulty in intubation or the need for invasive airway access. In pediatric patients, this is further complicated by a smaller airway diameter, lower oxygen reserves, and faster desaturation, which can quickly turn an unanticipated airway difficulty into a critical situation. Here, we present the airway management of a child with unanticipated difficult intubation secondary to an undiagnosed subglottic web.