The current status of corrective surgery for laryngomalacia

doi:10.1016/0196-0709(91)90123-W

American Journal of Otolaryngology

Volume 12, Issue 4, July–August 1991, Pages 230-235

https://doi.org/10.1016/0196-0709(91)90123-W Get rights and content

Abstract

When the airway obstruction related to laryngomalacia becomes significant, surgical correction of the underlying laryngeal deformity is indicated. The three elements of the supraglottic soft tissue that prolapses, namely, the corniculate mounds on the arytenoid cartilages, the shortened ary-epiglottic folds, and the omega shaped epiglottis, can all be appropriately “trimmed” using either conventional instruments or the surgical laser. Relief of symptoms is dramatic and, provided surgery is performed precisely and not during episodes of infection, complications should not occur. The aid of specialized, skillful anesthesia is required for this type of surgery. We present a series of 40 children with significant obstruction: 30% had neuromuscular disorders, 68% had an infantile epiglottis, seven required airway support prior to surgery, all had laser “supraglottic trimming,” and 13 required airway support after surgery. Relief of stridor and airway obstruction was generally rapid. There was only one complication: croup developing 4 days after surgery.

References (10)

NB Solomons et al.
Laryngomalacia: A review and the surgical management for severe cases
Int J Pediatr Otorhinolaryngol
(1987)
AB Seid et al.
Laser division of the ary-epiglottic folds for severe laryngomalacia
Int J Pediatr Otorhinolaryngol
(1985)
M Klein et al.
Relief of sleep related oropharyngeal airway obstruction by continuous insufflation of the pharynx
Lancet
(1986)
JR Belmont et al.
Congenital laryngeal stridor (laryngomalacia): Etiologic factors and associated disorders
Ann Otol Rhinol Laryngol
(1984)
JB Schulman et al.
Familial laryngomalacia: A case report
Laryngoscope
(1976)

There are more references available in the full text version of this article.

Cited by (29)

Laryngomalacia
2016, Seminars in Pediatric Surgery
Citation Excerpt :
A high proportion of patients with laryngomalacia have comorbid neurologic conditions. Reports range from 8 to 45% in children requiring operative management for their laryngomalacia.5,10,14,18–21 Broken down by disease severity, Thompson found an increase in concomitant neurologic disease as laryngomalacia severity worsened.
Laryngomalacia is the most common cause of stridor in neonates. It typically presents with inspiratory stridor and is often associated with feeding problems. Severe cases present with stridor, apnea, significant respiratory distress, and failure to thrive. Most patients are managed conservatively and can expect to see symptom resolution by 12–24 months of age. About 10% of patients require surgical treatment for their symptoms. Supraglottoplasty is the surgical technique of choice. Results of this surgery are excellent, and severe complications, such as supraglottic stenosis and aspiration, are uncommon. Supraglottoplasty is less effective in patients with significant comorbidities such as neurologic conditions and syndromes.
Endoscopic division of the ary-epiglottic folds in severe laryngomalacia
2001, International Journal of Pediatric Otorhinolaryngology
Objective: Laryngomalacia is the commonest cause of congenital stridor. The underlying anatomical abnormality associated with this condition is a prolapse of the supraglottic tissues into the laryngeal inlet during inspiration, and may involve the epiglottis, ary-epiglottic folds and the corniculate mounds of the arytenoids. However, it has been noted that the most consistent structural abnormality seen in these cases is the shortening of the ary-epiglottic folds and marked side to side curling of the epiglottis. We describe the follow-up and outcome of 33 cases treated by the simple division of the ary-epiglottic folds. Method: All case notes were reviewed with respect to indications of operation, age of operation, endoscopic findings, operative technique, complications and follow-up until resolution of symptoms. Results: Surgical outcomes could only be ascertained in only 32 patients. Twenty-two cases (68.7%) showed complete resolution of stridor and associated complications of laryngomalacia. In the remaining ten cases who could be followed up (31.2%), seven patients (21.8%) showed partial resolution with no further surgery required, two patients (6.2%) required additional excision of redundant mucosa as second procedure, one patient (3%) with associated cleft lip/palate and tracheomalacia had to undergo a tracheostomy. There was improvement in feeding after surgery in all the 12 patients (100%) who had had pre-operative feeding difficulties. All the four patients with cyanosis pre-operatively were cured, but one of the two patients with apnoeic episodes pre-operatively continued to have apnoeic spells despite resolution of their laryngomalacia. Conclusion: Simple endoscopic excision of the ary-epiglottic folds is a quick, reliable, highly effective procedure with very few complications. We recommend its use as the first line option in the management of severe laryngomalacia, with more extensive methods reserved for the very occasional case of primary failure.
Bifid epiglottis: a case report
1994, International Journal of Pediatric Otorhinolaryngology
Bifid epiglottis is a rare congenital laryngeal anomaly, usually associated with multiple congenital anomalies which include digital anomalies and hypothalamic pituitary dysfunction manifesting as growth retardation. A case is presented of a 2-year-old child with this picture in whom the bifid epiglottis prolapsed over the laryngeal inlet to cause inspiratory airway obstruction. Corrective surgery was not successful and eventually a partial epiglottectomy was required.
Laryngomalacia in a 12-year-old child after laryngeal mask use
2009, Journal of Laryngology and Otology
The incidence of postoperative aspiration among children undergoing supraglottoplasty for laryngomalacia
2015, Ear, Nose and Throat Journal
Laryngomalacia: A cause of cyanosis in pediatric age
2015, Advances in Dermatology Research

View all citing articles on Scopus

View full text

The current status of corrective surgery for laryngomalacia

Abstract

Int J Pediatr Otorhinolaryngol

Int J Pediatr Otorhinolaryngol

Lancet

Congenital laryngeal stridor (laryngomalacia): Etiologic factors and associated disorders

Ann Otol Rhinol Laryngol

Familial laryngomalacia: A case report

Laryngoscope