Asymmetric Epiglottic Development as a Cause of Difficult Laryngoscopy in a Neonate with Suspected Branchial Arch Hypoplasia: A Case Report.

Difficult laryngoscopy in syndromic children is usually attributed to mandibular or cervical abnormalities; however, supraglottic malformations may also impair laryngeal exposure. We describe three syndromic pediatric cases in which difficult laryngoscopy was associated with abnormal epiglottic morphology. In the index neonate with suspected left-sided branchial arch hypoplasia, bronchoscopy demonstrated ipsilateral hypoplasia of the epiglottis and arytenoid region, with the epiglottis arising unusually deep from the tongue base. These findings suggest that supraglottic malformation should be considered and that primary use of an age-appropriate video laryngoscope, with early flexible bronchoscopic guidance when needed, may facilitate safe airway management.