Diagnosis and management of postcricoid cushion in infants: A single-center experience

Objective

Postcricoid lesions in children encompass a diverse range of pathological alterations in the posterior cricoid area, involving the posterior pharyngeal wall, postcricoid mucosa, and adjacent soft tissues. These lesions can notably affect respiratory and swallowing functions, predominantly affecting infants and preschool-aged children.

Methods

A retrospective analysis was carried out on the clinical manifestations, diagnosis, treatment modalities, and prognosis of children diagnosed with postcricoid cushion admitted to our hospital from June 2020 to June 2025.

Results

Over a five-year period, our center managed 33 cases of children with postcricoid cushion. Among them, 23 cases were male (23/33) and 10 cases were female (10/33). The youngest patient was diagnosed immediately after birth, while the oldest was 4 years old, with a median age of 6.84 months. Laryngeal stridor and abnormal throat sounds were the primary reasons for patients seeking medical attention, with only two patients reporting feeding difficulties and milk choking. 10 cases underwent neck CT angiography (CTA) and 8 cases had magnetic resonance imaging (MRI). In both CTA and MRI results, the predominant local soft tissue thickening of the posterior pharyngeal wall was a frequently observed finding. Laryngomalacia emerged as the most prevalent comorbid laryngeal abnormality. Notably, among the ten children treated with propranolol, not even one demonstrated a significant therapeutic response.

Conclusion

The postcricoid cushion, a normal anatomical entity, warrants heightened attention from pediatricians. In most infants, laryngeal stridor or abnormal phonic emissions should elicit concerted vigilance among parents and clinicians. Given that laryngeal imaging modalities typically fail to characterize lesion, laryngoscopy remains paramount for establishing a definitive diagnosis, whereas specific interventions are generally unnecessary. Notably, the inefficacy of empirical β-blocker therapy (e.g., propranolol) underscores the imperative for systematic re-evaluation of diagnostic approaches to mitigate misdiagnosis risks.