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

Abstract

Congenital pharyngeal web is a rare anomaly almost always diagnosed in the paediatric population due to airway obstruction and feeding difficulties. The combination of congenital oropharyngeal and laryngopharyngeal web in an adult is extremely rare and has not commonly been published in the literature. We experienced a 47-year-old woman undiagnosed with pharyngeal web until difficult intubation upon surgery. A 47-year-old woman diagnosed with right ovarian complex cyst was scheduled for total laparoscopic hysterectomy and bilateral salpingo-oopherectomy. pharyngeal webs were incidentally found during intubation and necessitated a reschedule of surgery and tracheostomy. The patient had no history of dysphagia, weight loss or other symptoms of airway obstruction. Fibre optic laryngoscopic examination revealed a combination of congenital oropharyngeal and laryngopharyngeal webs. Patient denied previous history of caustic agent ingestion, oral airway surgeries, chemoradiation. After 2 days, awake tracheostomy with endoscopic guided coblator assisted excision of pharyngeal web was done first, followed by total laparoscopic hysterectomy and bilateral salpingo-oopherectomy in the same sitting. Coblation assisted excision of the pharyngeal web will allow the airway to be feasible for intubation in the future. Congenital pharyngeal webs are extremely rare findings, especially in adult patients. Prediction of difficult airways preoperatively is necessary to prevent difficult airway situations. Controlled ablation of the pharyngeal web gives a good outcome in terms of less post-operative pain and blood loss.