Abstracts
Laryngomalacia is the most frequent congenital abnormality of the larynx, accounting for approximately 60-75% of congenital stridor cases. Despite its benign and self-limited aspects, 10% of cases require intervention. Currently, supraglottoplasty is considered the standard treatment of severe laryngomalacia.
OBJECTIVE:
To describe the experience of the authors in the surgical treatment of patients with severe laryngomalacia. Methodology: A retrospective study.
METHOD:
The medical records of 11 consecutive cases of severe laryngomalacia who underwent surgical treatment between 2003 and 2012 were analyzed for age, gender, symptoms, associated diseases, surgical technique employed, extubation time, surgical complications, length of hospital stay and clinical outcome.
RESULTS:
Of the 11 cases of severe laryngomalacia, six patients (54.5%) were operated with the use of CO2 laser and five patients (45.5%) were submitted to the cold technique. Only 1 patient (9.1%) required surgical reintervention. There were no cases of surgical complications. All patients had clinical improvement.
CONCLUSION:
Supraglottoplasty proved to be effective and safe in the treatment of severe laryngomalacia.
airway handling; laryngomalacia; respiratory sounds
A laringomalácia é a anomalia congênita da laringe mais frequente, sendo responsável por cerca de 60% a 75% dos casos de estridor congênito. Apesar de seu curso benigno e autolimitado, 10% dos casos necessitam de intervenção. Atualmente, as supraglotoplastias são consideradas o tratamento padrão da laringomalácia grave.
OBJETIVO:
Descrever a experiência adquirida pelos autores no tratamento cirúrgico dos pacientes com laringomalácia grave. Metodologia: Estudo retrospectivo.
MÉTODO:
Os prontuários de 11 casos consecutivos de laringomalácia grave, submetidos ao tratamento cirúrgico entre 2003 e 2012, foram analisados quanto à idade, gênero, sintomas, doenças associadas, técnica cirúrgica adotada, tempo de extubação, complicações cirúrgicas, tempo de internação e evolução clínica.
RESULTADOS:
Dos 11 casos de laringomalácia grave, seis pacientes (54,5%) foram operados com o uso do laser de CO2 e em cinco pacientes (45,5%) foram realizadas a técnica a frio. Apenas um paciente (9,1%) necessitou reabordagem cirúrgica. Não foram observados casos de complicações cirúrgicas. Todos os pacientes apresentaram melhora clínica importante.
CONCLUSÃO:
A supraglotoplastia mostrou-se um procedimento eficaz e seguro no tratamento da laringomalácia grave.
laringomalácia; manuseio das vias aéreas; sons respiratórios
INTRODUCTION
Laryngomalacia is the most common congenital abnormality of the larynx,
accounting for about 60% to 75% of congenital stridor cases11. Valera FC, Tamashiro E, de Araújo MM, Sander HH, Küpper DS.
Evaluation of the efficacy of supraglottoplasty in obstructive sleep apnea
syndrome associated with severe laryngomalacia. Arch Otolaryngol Head Neck Surg.
2006;132(5):489-93. PMID: 16702563 DOI:
http://dx.doi.org/10.1001/archotol.132.5.489
DOI:
http://dx.doi.org/10.1001/ar...
2. Lee KS, Chen BN, Yang CC, Chen YC. CO2 laser supraglottoplasty
for severe laryngomalacia: a study of symptomatic improvement. Int J Pediatr
Otorhinolaryngol. 2007;71(6):889-95. PMID: 17416423 DOI:
http://dx.doi.org/10.1016/j.ijporl.2007.02.010
http://dx.doi.org/10.1016/j.ijporl.2007....
-
33. Bluestone CD, Healy GB, Cotton RT. Diagnosis of laryngomalacia is
not enough! Arch Otolaryngol Head Neck Surg.
1996;122(12):1417-8.. Although its pathogenesis is not fully understood, there is a collapse
of supraglottic tissues during inspiration44. Day KE, Discolo CM, Meier JD, Wolf BJ, Halstead LA, White DR.
Risk Factors for Supraglottoplasty Failure. Otolaryngol Head Neck Surg. 2011;
[Epub ahead of print].
,
55. Denoyelle F, Mondain M, Gresillon N, Roger G, Chaudre F,
Garabedian EN. Failures and complications of supraglottoplasty in children. Arch
Otolaryngol Head Neck Surg. 2003;129(10):1077-80. DOI: http://
dx.doi.org/10.1001/archotol.129.10.1077
http://dx.doi.org/10.1001/archotol.129.1...
, generating a high-frequency inspiratory stridor, exacerbated in the
supine position during feeding, agitation and crying66. Werner JA, Lippert BM, Dünne AA, Ankermann T, Folz BJ, Seyberth
H. Epiglottopexy for the treatment of severe laryngomalacia. Eur Arch
Otorhinolaryngol. 2002;259(9):459-64. PMID: 12386747
7. Richter GT, Thompson DM. The surgical management of
laryngomalacia. Otolaryngol Clin North Am. 2008;41(5):837-64. DOI: http://
dx.doi.org/10.1016/j.otc.2008.04.011
http://dx.doi.org/10.1016/j.otc.2008.04....
-
88. Gandhi S, Oswal V, Thekedar P, Mishra P. Role of transoral CO(2)
laser surgery for severe pediatric laryngomalacia. Eur Arch Otorhinolaryngol.
2011;268(10):1479-83. PMID: 21604072 DOI:
http://dx.doi.org/10.1007/s00405-011-1631-x
http://dx.doi.org/10.1007/s00405-011-163...
. This stridor usually appears in the first two weeks of life, with an
incidence peak around 6 months and spontaneous resolution in 90% of the cases by
the second year of life99. Senders CW, Navarrete EG. Laser supraglottoplasty for
laryngomalacia: are specific anatomical defects more influential than associated
anomalies on outcome? Int J Pediatr Otorhinolaryngol. 2001;57(3):235-44. PMID:
11223456 DOI: http://dx.doi.org/10.1016/S0165-5876(00)00461-4
http://dx.doi.org/10.1016/S0165-5876(00)...
,
1010. Zafereo ME, Taylor RJ, Pereira KD. Supraglottoplasty for
laryngomalacia with obstructive sleep apnea. Laryngoscope. 2008;118(10):1873-7.
PMID: 18641529 DOI:
http://dx.doi.org/10.1097/MLG.0b013e31817e7441
http://dx.doi.org/10.1097/MLG.0b013e3181...
. Despite its benign and self-limited nature, 10% of laryngomalacia cases
require intervention to relieve the respiratory obstruction1010. Zafereo ME, Taylor RJ, Pereira KD. Supraglottoplasty for
laryngomalacia with obstructive sleep apnea. Laryngoscope. 2008;118(10):1873-7.
PMID: 18641529 DOI:
http://dx.doi.org/10.1097/MLG.0b013e31817e7441
http://dx.doi.org/10.1097/MLG.0b013e3181...
,
1111. Toynton SC, Saunders MW, Bailey CM. Aryepiglottoplasty for
laryngomalacia: 100 consecutive cases. J Laryngol Otol. 2001;115(1):35-8. DOI:
http://dx.doi.org/10.1258/0022215011906966
http://dx.doi.org/10.1258/00222150119069...
.
Tracheotomy was considered the safest option for airway maintenance; however, it
has become an obsolete method, especially in the last 20 years with the advent
of minimally invasive endoscopic techniques. Although some authors advocate
hyomandibulopexy as a treatment for severe laryngomalacia, most operations
currently involve endoscopic procedures in the supraglottic region, the
so-called supraglottoplasties1111. Toynton SC, Saunders MW, Bailey CM. Aryepiglottoplasty for
laryngomalacia: 100 consecutive cases. J Laryngol Otol. 2001;115(1):35-8. DOI:
http://dx.doi.org/10.1258/0022215011906966
http://dx.doi.org/10.1258/00222150119069...
12. Dafico SR, Costa HO. Surgical treatment of laryngomalacia. ACTA
ORL/Técnicas em Otorrinolaringologia. 2008;26(2):75-9.
-
1313. Fraga JC, Schopf L, Volker V, Canani S. Endoscopic
supraglottoplasty in children with severe laryngomalacia with and without
neurological impairment. J Pediatr (Rio J). 2001;77(5):420-4. DOI:
http://dx.doi.org/10.2223/JPED.285
http://dx.doi.org/10.2223/JPED.285...
.
These techniques can be subdivided according to the anatomical region addressed.
When the aryepiglottic fold mucosa is excised, we call it: aryepiglottoplasty;
likewise, we call it arytenoidoplasty and epiglottoplasty when the
supra-arytenoid and epiglottis mucosae are resected, respectively. Other
variants described are: epiglottopexy - which corresponds to the lingual-face
attachment of the epiglottis to the base of the tongue, and epiglottectomy,
which corresponds to the epiglottis cartilage resection1414. Bourolias C, Hajiioannou J, Sobol E, Velegrakis G, Helidonis E.
Epiglottis reshaping using CO2 laser: a minimally invasive technique and its
potent applications. Head Face Med. 2008;4:15. DOI:
http://dx.doi.org/10.1186/1746-160X-4-15
http://dx.doi.org/10.1186/1746-160X-4-15...
.
The definition of severe laryngomalacia is based on the following clinical
criteria: apnea, cyanosis, respiratory failure, cor pulmonale, feeding
difficulties, low weight and height development, and uncontrollable
gastroesophageal reflux - which are severity indicators, being criteria for
surgical intervention1010. Zafereo ME, Taylor RJ, Pereira KD. Supraglottoplasty for
laryngomalacia with obstructive sleep apnea. Laryngoscope. 2008;118(10):1873-7.
PMID: 18641529 DOI:
http://dx.doi.org/10.1097/MLG.0b013e31817e7441
http://dx.doi.org/10.1097/MLG.0b013e3181...
,
1313. Fraga JC, Schopf L, Volker V, Canani S. Endoscopic
supraglottoplasty in children with severe laryngomalacia with and without
neurological impairment. J Pediatr (Rio J). 2001;77(5):420-4. DOI:
http://dx.doi.org/10.2223/JPED.285
http://dx.doi.org/10.2223/JPED.285...
,
1515. Schroeder JW Jr, Bhandarkar ND, Holinger LD. S Synchronous
airway lesions and outcomes in infants with severe laryngomalacia requiring
supraglottoplasty. Arch Otolaryngol Head Neck Surg. 2009;135(7):647-51. DOI:
http://dx.doi.org/10.1001/archoto.2009.73
http://dx.doi.org/10.1001/archoto.2009.7...
,
1616. Chan DK, Truong MT, Koltai PJ. Supraglottoplasty for occult
laryngomalacia to improve obstructive sleep apnea syndrome. Arch Otolaryngol
Head Neck Surg. 2012;138(1):50-4. DOI: http://dx.doi.
org/10.1001/archoto.2011.233
http://dx.doi.org/10.1001/archoto.2011.2...
.
The aim of this study is to describe the experience of the authors in the surgical treatment of patients with severe laryngomalacia evaluated in the pediatric ICU of a tertiary hospital.
METHOD
Longitudinal historical cohort study, with patient chart review and video recording of 11 surgical patients with severe laryngomalacia, submitted to supraglottoplasty from January 2003 to April 2012.
The charts and video documentation of procedures were obtained from the hospital medical files. We collected data regarding age, gender, symptoms, associated diseases, surgical technique used, extubation time, surgical complications, length of hospital stay and clinical outcome. This study was approved by the Research Ethics Committee, under protocol number 151.689.
RESULTS
Among the 11 cases evaluated for severe laryngomalacia, nine (81.8%) were males and two were (18.2%) females. All children in the study had stridor and respiratory distress - the main reason for hospitalization; and they were initially evaluated in the intensive care unit.
The time of surgery ranged from 1 to 12 months of age. All patients underwent suspension microlaryngoscopy, and supraglottoplasty was performed under general anesthesia and tracheal intubation (Figures 1 and 2 of case number 3).
Intraoperative aspect of a 3 - month old child with laryngomalacia, detail of the aryepiglottic fold shortening.
Postoperatively, all patients were monitored in the intensive care unit. Five patients were extubated after a 48-hour period, four in the immediate post-op and two cases had extubation after 3 and 9 days, respectively.
Only one patient (9.1%) submitted to cold aryepiglottoplasty and extubated in the immediate postoperative period, there was airway obstruction recurrence, which required a new surgical approach, this time using the CO2 laser.
There were no cases of surgical complications. All patients had significant stridor and respiratory distress. Data such as age, gender, signs/symptoms, associated disorders, surgery, extubation time, length of hospital stay and clinical outcomes are described on Table 1.
DISCUSSION
Consistent with the medical literature, there was a predominance of
laryngomalacia cases among male patients22. Lee KS, Chen BN, Yang CC, Chen YC. CO2 laser supraglottoplasty
for severe laryngomalacia: a study of symptomatic improvement. Int J Pediatr
Otorhinolaryngol. 2007;71(6):889-95. PMID: 17416423 DOI:
http://dx.doi.org/10.1016/j.ijporl.2007.02.010
http://dx.doi.org/10.1016/j.ijporl.2007....
,
1717. Avelino MA, Liriano RY, Fujita R, Pignatari S, Weckx LL.
Treatment laryngomalacia: experience with 22 cases. Braz J Otorhinolaryngol.
2005;71(3):330-4. PMID: 16446937. The inspiratory stridor was considered the most important symptom of
the disease, being present in all patients.11. Valera FC, Tamashiro E, de Araújo MM, Sander HH, Küpper DS.
Evaluation of the efficacy of supraglottoplasty in obstructive sleep apnea
syndrome associated with severe laryngomalacia. Arch Otolaryngol Head Neck Surg.
2006;132(5):489-93. PMID: 16702563 DOI:
http://dx.doi.org/10.1001/archotol.132.5.489
DOI:
http://dx.doi.org/10.1001/ar...
,
66. Werner JA, Lippert BM, Dünne AA, Ankermann T, Folz BJ, Seyberth
H. Epiglottopexy for the treatment of severe laryngomalacia. Eur Arch
Otorhinolaryngol. 2002;259(9):459-64. PMID: 12386747
In the preoperative classification of laryngomalacia, we rely on clinical signs,
i.e., the severity of the disease and not the anatomical classification
presented by Holinger & Konior1818. Holinger LD, Konior RJ. Surgical management of severe
laryngomalacia. Laryngocope. 1989;99(2):136-42.. Most authors indicate the procedure in cases of severe
laryngomalacia.11. Valera FC, Tamashiro E, de Araújo MM, Sander HH, Küpper DS.
Evaluation of the efficacy of supraglottoplasty in obstructive sleep apnea
syndrome associated with severe laryngomalacia. Arch Otolaryngol Head Neck Surg.
2006;132(5):489-93. PMID: 16702563 DOI:
http://dx.doi.org/10.1001/archotol.132.5.489
DOI:
http://dx.doi.org/10.1001/ar...
,
22. Lee KS, Chen BN, Yang CC, Chen YC. CO2 laser supraglottoplasty
for severe laryngomalacia: a study of symptomatic improvement. Int J Pediatr
Otorhinolaryngol. 2007;71(6):889-95. PMID: 17416423 DOI:
http://dx.doi.org/10.1016/j.ijporl.2007.02.010
http://dx.doi.org/10.1016/j.ijporl.2007....
Likewise, we indicated the surgical procedure based on a number of
factors, including the development delays, feeding issues, severe
gastroesophageal reflux, and especially the manifestations resulting from airway
obstruction.
Although the results presented in the literature are statistically similar with
respect to the use of CO2 laser and the cold approach1919. Loke D, Ghosh S, Panarese A, Bull PD. Endoscopic division of the
ary-epiglottic folds in severe laryngomalacia. Int J Pediatr Otorhinolaryngol.
2001;60(1):59-63. PMID: 11434955 DOI: http://dx.doi.
org/10.1016/S0165-5876(01)00515-8
http://dx.doi.org/10.1016/S0165-5876(01)...
, in our experience the CO2 laser offers lower risk of
intraoperative bleeding and postoperative edema in cases of greater mucosal
resection, as in epiglottoplasty and arytenoidoplasty. Clinical outcome was
favorable in all our patients, regardless of the technique and instruments
employed. We also emphasize that we have no experience in the treatment of
laryngomalacia by the potassium-titanium-phosphate (KTP) laser2020. Soong WJ, Shiao AS, Jeng MJ, Lee YS, Tsao PC, Yang CF, et al.
Comparison between rigid and flexible laser supraglottoplasty in the treatment
of severe laryngomalacia in infants. Int J Pediatr Otorhinolaryngol.
2011;75(6):824-9. PMID: 21513991 DOI:
http://dx.doi.org/10.1016/j.ijporl.2011.03.016
http://dx.doi.org/10.1016/j.ijporl.2011....
or microdebrider1919. Loke D, Ghosh S, Panarese A, Bull PD. Endoscopic division of the
ary-epiglottic folds in severe laryngomalacia. Int J Pediatr Otorhinolaryngol.
2001;60(1):59-63. PMID: 11434955 DOI: http://dx.doi.
org/10.1016/S0165-5876(01)00515-8
http://dx.doi.org/10.1016/S0165-5876(01)...
, as per suggested by some authors.
The first study to systematically examine the unilateral supraglottoplasty was
published in 1995 by Kelly & Gray2121. Reddy DK, Matt BH. Unilateral vs. bilateral supraglottoplasty
for severe laryngomalacia in children. Arch Otolaryngol Head Neck Surg.
2001;127(6):694-9. PMID: 11405871 DOI: http://dx.doi.org/10.1001/
archotol.127.6.694
http://dx.doi.org/10.1001/archotol.127.6...
. The authors had a successful surgery in 94% of cases without major
complications in a study involving 18 patients. Only three patients required a
bilateral aryepiglottic fold approach. Loke et al.1919. Loke D, Ghosh S, Panarese A, Bull PD. Endoscopic division of the
ary-epiglottic folds in severe laryngomalacia. Int J Pediatr Otorhinolaryngol.
2001;60(1):59-63. PMID: 11434955 DOI: http://dx.doi.
org/10.1016/S0165-5876(01)00515-8
http://dx.doi.org/10.1016/S0165-5876(01)...
performed the technique bilaterally in 33 patients, with complete
resolution of stridor in 22 cases (68.7%), partial resolution in seven (21.8%),
re-operation surgery in two patients; and one patient with multiple
malformations underwent tracheostomy. Considering the 19% to 45% rate of
surgical revisions described in the literature44. Day KE, Discolo CM, Meier JD, Wolf BJ, Halstead LA, White DR.
Risk Factors for Supraglottoplasty Failure. Otolaryngol Head Neck Surg. 2011;
[Epub ahead of print].- with an even higher percentage of unilateral supraglottoplasty
cases88. Gandhi S, Oswal V, Thekedar P, Mishra P. Role of transoral CO(2)
laser surgery for severe pediatric laryngomalacia. Eur Arch Otorhinolaryngol.
2011;268(10):1479-83. PMID: 21604072 DOI:
http://dx.doi.org/10.1007/s00405-011-1631-x
http://dx.doi.org/10.1007/s00405-011-163...
, we adopt the bilateral aryepiglottoplasty as the procedure of choice at
our institution. Thus, the epiglottoplasty and arytenoidoplasty are kept as a
complementary method to aryepiglottoplasty, when this alone is not sufficient to
improve the supraglottic obstruction.
Complications of supraglottoplasty include bleeding, infection, edema,
aspiration, dysphagia, supraglottic stenosis, synechia, respiratory failure and
death22. Lee KS, Chen BN, Yang CC, Chen YC. CO2 laser supraglottoplasty
for severe laryngomalacia: a study of symptomatic improvement. Int J Pediatr
Otorhinolaryngol. 2007;71(6):889-95. PMID: 17416423 DOI:
http://dx.doi.org/10.1016/j.ijporl.2007.02.010
http://dx.doi.org/10.1016/j.ijporl.2007....
,
44. Day KE, Discolo CM, Meier JD, Wolf BJ, Halstead LA, White DR.
Risk Factors for Supraglottoplasty Failure. Otolaryngol Head Neck Surg. 2011;
[Epub ahead of print].
,
1414. Bourolias C, Hajiioannou J, Sobol E, Velegrakis G, Helidonis E.
Epiglottis reshaping using CO2 laser: a minimally invasive technique and its
potent applications. Head Face Med. 2008;4:15. DOI:
http://dx.doi.org/10.1186/1746-160X-4-15
http://dx.doi.org/10.1186/1746-160X-4-15...
,
2222. Fattah HA, Gaafar AH, Mandour ZM. Laryngomalacia: Diagnosis and
management. Egypt J Ear Nose Throat Allied Sci. 2011;12(3):149-53. DOI:
http://dx.doi.org/10.1016/j.ejenta.2011.12.001
http://dx.doi.org/10.1016/j.ejenta.2011....
. Denoyelle et al.55. Denoyelle F, Mondain M, Gresillon N, Roger G, Chaudre F,
Garabedian EN. Failures and complications of supraglottoplasty in children. Arch
Otolaryngol Head Neck Surg. 2003;129(10):1077-80. DOI: http://
dx.doi.org/10.1001/archotol.129.10.1077
http://dx.doi.org/10.1001/archotol.129.1...
reported a 7.4% complication rate in 136 patients undergoing bilateral
supraglottoplasty, and five patients developed supraglottic stenosis. Although
this risk has been hypothesized, current studies indicate excessive removal of
laryngeal tissues rather than bilateral aryepiglotoplasty2323. Thompson DM. Abnormal sensorimotor integrative function of the
larynx in congenital laryngomalacia: a new theory of etiology. Laryngoscope.
2007;117(6 Pt Suppl 114): 1-33. as the main risk factor for the occurrence of complications. No major
complication was described in our study.
Schroeder et al.2424. Schroeder JW Jr, Thakkar KH, Poznanovic SA, Holinger LD.
Aspiration following CO(2) laser-assisted supraglottoplasty. Int J Pediatr
Otorhinolaryngol. 2008;72(7):985-90. DOI:
http://dx.doi.org/10.1016/j.ijporl.2008.03.007
http://dx.doi.org/10.1016/j.ijporl.2008....
warned that the risk of liquid aspiration during the pharyngeal phase of
swallowing is more common in patients undergoing supraglottoplasty by
CO2 laser, the main risk factor for the presence of preoperative
aspiration. In our study, only one patient underwent aryepiglottoplasty with
epiglottoplasty presented with transient aspiration with improvements after the
conservative approach.
In a review of 84 cases O'Donnell et al.2525. O'Donnell S, Murphy J, Bew S, Knight LC. Aryepiglottoplasty for
laryngomalacia: results and recommendations following a case series of 84. Int J
Pediatr Otorhinolaryngol. 2007;71(8):1271-5. PMID: 17597233 DOI:
http://dx.doi.org/10.1016/j.ijporl.2007.05.001
http://dx.doi.org/10.1016/j.ijporl.2007....
concluded that the majority of patients submitted to aryepiglottoplasty
to treat laryngomalacia are able to return home after an overnight stay at the
hospital. We have not adopted this recommendation, believing it to be prudent
monitoring patients in intensive care unit for a minimum of 24 hours, even in
cases of extubation immediately after surgery. This provides further support for
possible cases of airway obstruction and lower anxiety by relatives.
Toynton et al.1111. Toynton SC, Saunders MW, Bailey CM. Aryepiglottoplasty for
laryngomalacia: 100 consecutive cases. J Laryngol Otol. 2001;115(1):35-8. DOI:
http://dx.doi.org/10.1258/0022215011906966
http://dx.doi.org/10.1258/00222150119069...
reported an incidence of 47%, and Friedman et al.2626. Sakakura K, Chikamatsu K, Toyoda M, Kaai M, Yasuoka Y, Furuya N.
Congenital laryngeal anomalies presenting as chronic stridor: a retrospective
study of 55 patients. Auris Nasus Larynx. 2008;35(4):527-33. PMID: 18262373 DOI:
http://dx.doi.org/10.1016/j.anl.2007.12.001
http://dx.doi.org/10.1016/j.anl.2007.12....
reported an incidence of 65% of synchronous airway lesions, especially
in patients with severe laryngomalacia undergoing supraglottoplasty, this being
one of the possible causes of treatment failure. Although this index is quite
considerable, we do not generalize the use of bronchoscopy as a means of
diagnosis, being a test of exception. Our diagnosis is based on clinical and
nasal-laryngoscopy findings. There were no cases of synchronous lesions in our
patients.
Finally, the diagnosis of laryngomalacia is not commonly observed in the general
population, being restricted mostly to the tertiary level of care1111. Toynton SC, Saunders MW, Bailey CM. Aryepiglottoplasty for
laryngomalacia: 100 consecutive cases. J Laryngol Otol. 2001;115(1):35-8. DOI:
http://dx.doi.org/10.1258/0022215011906966
http://dx.doi.org/10.1258/00222150119069...
, with spontaneous resolution in most cases2727. Martin JE, Howarth KE, Khodaei I, Karkanevatos A, Clarke RW.
Aryepiglottoplasty for laryngomalacia: the Alder Hey experience. J Laryngol
Otol. 2005;119(12):958-60. PMID: 16354358 DOI:
http://dx.doi.org/10.1258/002221505775010904
http://dx.doi.org/10.1258/00222150577501...
28. Ahmad SM, Soliman AM. Congenital anomalies of the larynx.
Otolaryngol Clin North Am. 2007;40(1):177-91. DOI:
http://dx.doi.org/10.1016/j.otc.2006.10.004
http://dx.doi.org/10.1016/j.otc.2006.10....
29. Siou GS, Jeannon JP, Stafford FW. Acquired idiopathic
laryngomalacia treated by laser aryepiglottoplasty. J Laryngol Otol.
2002;116(9):733-5. PMID: 12437813 DOI:
http://dx.doi.org/10.1258/002221502760238073
http://dx.doi.org/10.1258/00222150276023...
-
3030. Manning SC, Inglis AF, Mouzakes J, Carron J, Perkins JA.
Laryngeal anatomic differences in pediatric patients with severe laryngomalacia.
Arch Otolaryngol Head Neck Surg. 2005;131(4):340-3. PMID: 15837904 DOI:
http://dx.doi.org/10.1001/archotol.131.4.340
http://dx.doi.org/10.1001/archotol.131.4...
. The success rate of supraglottoplasty described in the literature
varies from 38% to 100%44. Day KE, Discolo CM, Meier JD, Wolf BJ, Halstead LA, White DR.
Risk Factors for Supraglottoplasty Failure. Otolaryngol Head Neck Surg. 2011;
[Epub ahead of print].. In our series, the clinical improvement of all patients submitted to
surgical treatment ensured a success rate of 100% of cases.
CONCLUSION
Supraglottoplasty proved to be an effective procedure in the treatment of respiratory obstruction, enlarging the laryngeal lumen. Due to its high resolution and low complication rate, it is a safe procedure in the treatment of children with severe laryngomalacia, ensuring clinical improvement for the patients.
REFERÊNCIAS
-
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Nucleus of Otorhinolaryngology and Head and Neck Surgery of São Paulo.
Publication Dates
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Publication in this collection
Sep-Oct 2013
History
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Received
20 Feb 2013 -
Accepted
14 June 2013