Omega-shaped epiglottis: a challenge

Veiga, Joana Filipa; Gomes, Carlos

doi:10.1016/j.bjane.2021.02.038

Cited by 3 publications

(7 citation statements)

References 3 publications

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“…A total of 33 studies were included in our review 9‐11,19‐48 . A PRISMA diagram outlining our search is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…27,46 There were 17 patients from 13 studies with an idiopathic etiology, or one that was not necessarily specified. 11,20,21,[28][29][30][31][32]34,40,43,45,48 Seven studies specifically described the patient's symptoms as adult or acquired laryngomalacia. 11,21,28,30,32,43,48 Four studies reference reports of ALM in their descriptions.…”

Section: Heterogeneity Of Included Patientsmentioning

confidence: 99%

“…20,29,31,40 One study mentions congenital laryngomalacia, but does not specifically mention ALM, 34 and 1 study mentions "laryngomalacia" but does not specify between congenital versus aquired. 45 The remaining 13 patients from 11 studies had varying suspected etiologies that included traumatic, postsurgical, related to OSA, compression from a mass, or secondary to an inherited disease. 9,10,22,[24][25][26][27]33,35,38,44 Six studies specifically describe the patient's symptoms as adult or acquired larnygomalacia, 10,22,26,35,38,44 while 2 studies did not mention ALM in their description.…”

Section: Heterogeneity Of Included Patientsmentioning

confidence: 99%

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Adult Laryngomalacia: A Scoping Review

Mills,

Monaghan,

Nguyen

et al. 2024

Otolaryngol.--head neck surg.

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ObjectiveThis review sought to determine the characteristics of adults diagnosed with new onset laryngomalacia including airway symptoms, laryngoscopic findings, treatments, and outcomes. Moreover, we wanted to highlight suspected limitations in the literature.Data SourcesStudies were identified through CINAHL, Cochrane Review, PubMed, and Scopus published between 1966 and 2023.Review MethodsThe search was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐analysis Extension for Scoping Reviews checklist by 2 independent investigators. A meta‐analysis of proportions and continuous measures was conducted.ResultsOf the 1121 abstracts identified, 33 articles pertaining to laryngomalacia in the adult population were included. The most common presenting symptoms were stridor at rest (78.3%, 65.1‐88.3) and dyspnea with exertion (83.8%, 64.8‐96.3). The most suspected etiology was exercise‐induced (86.0%, 69.4‐95.5), and the most common description of laryngomalacia on visualization was collapse of supraglottic structures during exercise (93.3%, 79.0‐99.1). Nonsurgical options were attempted in 87.0% (54.0‐99.1), which included oral appliances, respiratory retraining, breathing techniques, and working with a speech pathologist. Surgical options were ultimately performed in 84.2% (75.0‐91.0). Complete resolution of symptoms following therapy was seen in 61.9% (48.0‐74.6).ConclusionAdult onset laryngomalacia is difficult to characterize. It typically presents in patients during exercise, with neurological injury, or idiopathically. Surgical management can lead to improvement or complete resolution of symptoms. The need for a universal nomenclature is highlighted in this review, as it is inconsistently classified.

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“…A total of 33 studies were included in our review 9‐11,19‐48 . A PRISMA diagram outlining our search is shown in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

Section: Heterogeneity Of Included Patientsmentioning

confidence: 99%

Section: Heterogeneity Of Included Patientsmentioning

confidence: 99%

See 1 more Smart Citation

Adult Laryngomalacia: A Scoping Review

Mills,

Monaghan,

Nguyen

et al. 2024

Otolaryngol.--head neck surg.

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show abstract

“…Additionally, we encourage the strategy of overriding the epiglottis entirely and using the curved blade tip to lift the OSE upwards with a technique usually reserved for straight laryngoscope blades, which has been described elsewhere. 5 …”

Section: Diagnosismentioning

confidence: 99%

“…A bougie‐assisted strategy will allow for easier access between the narrow folds of the OSE and into the glottic opening. Additionally, we encourage the strategy of overriding the epiglottis entirely and using the curved blade tip to lift the OSE upwards with a technique usually reserved for straight laryngoscope blades, which has been described elsewhere 5 …”

Section: Diagnosismentioning

confidence: 99%

Uncommon anatomical variation of an epiglottis encountered during emergent endotracheal intubation

Barnicle

Bracey

2022

JACEP Open

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Successful reversal of remimazolam anesthesia in a “cannot intubate, can ventilate” situation: a case report

Sekimoto¹,

Kiyama²,

Uezono³

2023

JA Clin Rep

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Background Compared to other intravenous anesthetics, availability of a specific antagonist flumazenil is a clear advantage of remimazolam. We report a patient who could be rapidly woken up when laryngoscopy and tracheal intubation were unexpectedly difficult. Case presentation A 62-year-old man was scheduled to have resection of a small gingival tumor. Preoperative airway examination was unremarkable except for an omega-shaped epiglottis. Anesthesia was induced with remifentanil/remimazolam infusion and rocuronium. A small omega-shaped edematous epiglottis precluded identification of glottis. Consciousness and spontaneous ventilation were rapidly restored after administration of flumazenil and sugammadex. Tracheostomy was done under local anesthesia while the patient breathed spontaneously. Conclusions Remimazolam can be a reasonable induction agent when there are concerns regarding airway management. Avoiding repeated airway manipulations is extremely important to prevent deterioration into a “cannot intubate, cannot ventilate (CICV)” emergency.

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Omega-shaped epiglottis: a challenge

Cited by 3 publications

References 3 publications

Adult Laryngomalacia: A Scoping Review

Adult Laryngomalacia: A Scoping Review

Uncommon anatomical variation of an epiglottis encountered during emergent endotracheal intubation

Successful reversal of remimazolam anesthesia in a “cannot intubate, can ventilate” situation: a case report

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