Laryngomalacia: A Review and Case Report of Surgical Treatment With Resolution of Pectus Excavatum

Lane, Ronald W.; Weider, Dudley J.; Steinem, Cynthia; Marín-Padilla, Miguel

doi:10.1001/archotol.1984.00800340058017

Cited by 111 publications

(79 citation statements)

References 26 publications

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“…In our study, there was no predominance of gender, even though some authors reported predominance of male patients 2,10 . The clinical picture of inspiration stridor found in all our patients with furculum retraction intensified by efforts, is considered the most characteristic by all authors, as well as stridor that may be present since birth or manifest in the first weeks of life.…”

Section: Discussioncontrasting

confidence: 66%

O tratamento da laringomalácia: experiência em 22 casos

Avelino

Liriano

Fujita

et al. 2005

Rev. Bras. Otorrinolaringol.

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Laryngomal acia is the most frequent cause of stridor in childhood, and in most of the cases, spontaneous resolution occurs by the age of 2 years. Approximately 10% of the cases (severe laryngomalacia) require surgery. This condition is of unknown etiology and its diagnosis is made by fiberoptic laryngoscopy, which shows shortening of the aryepiglottic folds, and/or redundant arytenoid mucosa, and/or anterior-posterior epiglottic prolapse. Aim: Our objective was to verify the main clinical and anatomical affections and to highlight the clinical parameters for clinical follow-up and surgical indication in patients with laryngomalacia. Study design: Transversal cohort study. Material and Method: Twenty-two children diagnosed with laryngomalacia in the Pediatric Otorhinolaryngology of UNIFESP-EPM, from January 2001 to December 2003, whose clinical and surgical follow-up were performed by the same examiner, were enrolled in this study. Results: Out of twenty-two evaluated children, 2 (9.1%) presented with severe laryngomalacia and pectus excavatum (funnel chest). At polysomnography, no child presented any significant respiratory event during sleeping. Those two children with severe laryngomalacia were submitted to supraglottoplasty with resection of the aryepiglottic folds. Conclusion: We concluded that stridor and shortening of the aryepiglottic folds are preponderant in children with laryngomalacia. The polysomnographic exam did not prove to be a good parameter for clinical follow-up, neither for surgical indication. The most important parameters were pectus excavatum and failure to thrive. Supraglottoplasty is effective and has low morbidity rate.

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Section: Discussioncontrasting

confidence: 66%

O tratamento da laringomalácia: experiência em 22 casos

Avelino

Liriano

Fujita

et al. 2005

Rev. Bras. Otorrinolaringol.

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“…Several anatomic changes of the supraglottis are observed in laryngomalacia [2][3][4]. Immaturity of the laryngeal cartilage has been proposed to be a contributing factor [5,6]. Increasing evidence suggests a neurologic etiology: altered sensorimotor integrative function of the larynx leads to neuromuscular hypotonia of the pharyngolaryngeal structures causing supraglottic collapse during inspiration [7].…”

Section: Discussionmentioning

confidence: 99%

“…It is characterized by a dynamic obstruction of the upper airway due to an inward collapse of supraglottic structures during inspiration. Although several theories have been postulated [2][3][4][5][6][7], the exact etiology of laryngomalacia is not fully understood and different factors may contribute to the disease [6,8], notably gastroesophageal reflux [9][10]. Laryngomalacia typically presents with a moderate to high-pitched fluttering inspiratory stridor being more marked during increased air demands.…”

Section: Introductionmentioning

confidence: 99%

Management of laryngomalacia in children with congenital syndrome: The role of supraglottoplasty

Escher

Probst

Gysin

2015

Journal of Pediatric Surgery

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BACKGROUND/IMPORTANCE: Supraglottoplasty is the surgical procedure of choice for severe laryngomalacia and has shown to be successful in most cases; however, patients with medical comorbidities present a higher rate of failure. To date, the best management of laryngomalacia in children with congenital syndrome remains unclear. PURPOSE: To study the outcome of supraglottoplasty in children with severe laryngomalacia, and to analyze the management and outcome in infants with a congenital syndrome. METHODS: Retrospective medical records review from January 2003 to October 2012 of all patients who underwent laser supraglottoplasty for severe laryngomalacia at the University Children's Hospital Zurich, Switzerland. RESULTS: Thirty-one patients were included; median age at time of surgery was 3.5 months. Three patients (10%) had a genetically proven congenital syndrome with associated neurologic anomalies. Overall success rate was 87%. Failures were observed in four (13%) of 31 cases; including all three patients presenting a congenital syndrome. CONCLUSIONS: Supraglottoplasty is an effective and safe treatment for laryngomalacia in otherwise healthy children. Signs of a possible underlying predominant neurologic origin and discrepancy between the clinical presentation and the endoscopic findings have to be taken into account, as in children with congenital syndrome with neurologic anomalies the risk of failure is higher.

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“…Schwartz, em 1944, 10 propôs que a laringomalacia grave poderia ser tratada através da ressecção cirúrgica dos bordos laterais da epiglote. Entretanto, foi somente em 1984 que Lane et al 11 , pela primeira vez, propuseram que a laringomalacia grave deveria ser tratada através da ressecção endoscópica da mucosa redundante de uma ou de ambas as aritenóides, e de ressecção das bordas laterais da epiglote. Desde então, vários trabalhos têm mostrado bons resultados com esta técni-ca [12][13][14][15] .…”

Section: Discussionunclassified

Supraglotoplastia endoscópica em crianças com laringomalacia grave com e sem doença neurológica associada

Fraga¹,

Schopf²,

Volker³

et al. 2001

J. Pediatr. (Rio J.)

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ResumoObjetivos: descrever as indicações e resultados da supraglotoplastia endoscópica em crianças com e sem lesão neurológica que apresentavam laringomalacia grave.Métodos: estudo retrospectivo de 8 crianças com laringomalacia grave submetidas a supraglotoplastia endoscópica com material de microcirurgia. Quatro crianças tinham paralisia cerebral (todas masculinas, idade média 6 anos) e 4 eram crianças sem doença neurológica (3 femininas, idade média de 11,5 meses). As indicações da cirurgia foram dificuldade respiratória em repouso e/ou esforço, dificuldade de deglutição, deficiência de crescimento e baixa saturação transcutânea de oxigênio. Estudo polissonográfico realizado nas últimas duas crianças mostrou dessaturação na oximetria, apnéia e hipoventilação durante o sono. As crianças receberam corticóide e antibiótico no pré-operatório.Resultados: todas as crianças sem doença neurológica apresentaram melhora significativa do estridor e da obstrução ventilatória. Das crianças com paralisia cerebral, uma necessitou traqueostomia logo após a cirurgia por edema e tecido de granulação supraglótico. As outras três apresentaram melhora clínica inicial, mas pioraram progressivamente, apesar da realização de outros procedimentos: uma necessitou nova supraglotoplastia após 6 meses; outra necessitou traqueostomia após 7 meses. Aquelas sem traqueostomia persistem com obstrução ventilatória grave. Não foi observada complicação do procedimento cirúrgico.Conclusões: 1) a supraglotoplastia é bem tolerada e sem complicações na criança; 2) a supraglotoplastia, neste estudo, mostrouse eficaz no tratamento da laringomalacia grave em crianças sem paralisia cerebral; entretanto, a supraglotoplastia não melhorou a obstrução ventilatória de crianças com paralisia cerebral e laringomalacia grave. AbstractObjective: to describe indications and results of supraglottoplasty for severe laryngomalacia in children with or without neurological impairment.Methods: eight children with severe laryngomalacia submitted to endoscopic supraglottoplasty were retrospectively studied. Four had neurological impairment (male, mean age 6 years), and 4 did not present neurological problems (3 female, mean age 11.5 months). Surgery indications were respiratory distress, feeding difficulties, failure to thrive, and low oxygen saturation. Polysomnographic evaluation was carried out on the last 2 children, showing abnormal oxygen saturation, obstructive apnea, and hypoventilation. All children received preoperative antibiotics and corticosteroids.Results: all children without neurological impairment had significant relief of symptoms. Children with neurological impairment had different outcome: one needed tracheotomy immediately after surgery due to edema and supraglottic granulation tissue. The other three children presented initial relief of symptoms, but subsequent follow-up showed progressive airway obstruction: one needed another endoscopic surgery 6 months later; other needed tracheotomy 7 months later. The children who were not submitted to tracheos...

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Laryngomalacia: A Review and Case Report of Surgical Treatment With Resolution of Pectus Excavatum

Cited by 111 publications

References 26 publications

O tratamento da laringomalácia: experiência em 22 casos

O tratamento da laringomalácia: experiência em 22 casos

Management of laryngomalacia in children with congenital syndrome: The role of supraglottoplasty

Supraglotoplastia endoscópica em crianças com laringomalacia grave com e sem doença neurológica associada

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