Comparative study between mucosal flap microsuturing and keel insertion for the management of anterior glottic webs

Abstract Objective To compare the surgical outcomes, including recurrence rates and postoperative grading, of two endoscopic techniques for managing anterior glottic webs (AGW): mucosal flap microsuturing versus endoscopic keel insertion. Methods Thirty patients with Cohen’s grade I-III AGW were enrolled between October 2022 and June 2024. Patients were allocated into two groups: Group A ( n = 15) underwent endoscopic web incision and mucosal flap microsuturing, and Group B ( n = 15) underwent endoscopic web incision and placement of a reinforced silicone keel. Patient demographics, etiology, pre-operative Cohen’s grade, and recurrence status were recorded. Results The mean age was comparable between Group A (13.63 ± 14.96 years) and Group B (12.32 ± 5.52 years) ( p = 0.75). Most cases were congenital (93.3% in Group A, 100% in Group B). Group B had a significantly higher proportion of recurrent cases pre-operatively (80% vs. 26.7%, p = 0.003). Pre-operatively, the majority of webs were grade III (86.7% in Group A, 100% in Group B). At 3 months, the success rate was 66.6% (10/15) in Group A and 80% (12/15) in Group B, with no statistically significant difference ( p = 0.39). No patients required tracheostomy in either group. Conclusion Both mucosal flap microsuturing and keel insertion are effective endoscopic techniques for managing anterior glottic webs, with no significant difference in recurrence rates. The choice of procedure can be individualized; microsuturing offers a single-stage operation, while keel insertion is a technically simpler option and may be preferable in complex or recurrent cases where viable mucosal flaps are scarce.