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PAEDIATRIC LARYNGOLOGY                         203

In very minor cases the U-shaped indentation of the cricoid lamina fills with
granulations and these interarytenoid granulations seen on laryngoscopy may
be misdiagnosed as pachydermia.

Micrognathia (hypoplasia of the mandible, Fig. 102) can cause stridor or an
inadequate airway because the tongue is displaced posteriorly. In the Pierre-
Robin syndrome a cleft palate is associated with the micrognathia and the

Fig. 102. Hypoplasia of the mandible

Fig. 103. Lipiodol swallow in dysphagia lusoria
due to congenital vascular ring.

stridor is marked. The treatment of this is the Beverly-Douglas procedure in
which the tongue is fixed anteriorly. Micrognathia may also be seen in the
Treacher-Collins syndrome.

Vascular anomalies may cause a chronic stridor in infants often accompanied
by a persistent brassy cough. If disorders of swallowing accompany the
condition it is called 'dysphagia lusoria'. The common causes are: (a) a right