Abstract
INTRODUCTION TO THE TOPICPrevious 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 PRESENTATIONWe 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.CONCLUSIONSPharyngeal webs are rare findings, particularly in adult patients. These congenital anomalies can be safely and effectively treated endoscopically via coblation.
Highlights
TO THE TOPICPrevious reports of congenital pharyngeal webs, rare, have been described in children
Pharyngeal webs are rare congenital anomalies characterized by mucosal bands extending from the posterior pharyngeal wall anteriorly to the glottis, which is the opening between the vocal cords.[1]
We report the second reported case of a congenital hypopharyngeal web in an adult patient and describe the potential functional and clinical implications of this anomaly
Summary
Pharyngeal webs are rare congenital anomalies characterized by mucosal bands extending from the posterior pharyngeal wall anteriorly to the glottis, which is the opening between the vocal cords.[1]. Within the hypopharynx (most inferior portion of the pharynx), a large midline web (red arrow in Figure 2) extended from the posterior cricoid area (region of the throat just behind the cricoid cartilage) and right pyriform sinus (subsite of the hypopharynx that act as a lateral channel for the passage of boluses into the esophagus) to the posterior pharyngeal wall, essentially separating the right pyriform sinus from the remainder of the pharyngeal inlet. This was located at 16 cm from the incisors with no overlying ulceration.
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