Laryngomalacia: Diagnosis and management

Fattah, Hisham Abedl; Gaafar, Alaa; Mandour, Zeyad

doi:10.1016/j.ejenta.2011.12.001

Cited by 7 publications

(23 citation statements)

References 32 publications

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“…Laringomalasia (LM) merupakan keadaan yang menggambarkan kolapsnya struktur supraglotis laring selama inspirasi sehingga mengakibatkan menyempitnya aliran udara selama inspirasi. [1][2][3][4] Sekitar 60-75 % kasus stridor kongenital disebabkan oleh LM. 2,3 Istilah laringomalasia pertama kali diperkenalkan oleh Jackson dan Jackson pada tahun 1942 untuk menggambarkan stridor inspirasi kongentital akibat kolapsnya struktur laring saat inspirasi dimana kejadian ini tidak ditemukan pada stridor inspirasi kongenital lainnya.…”

Section: Pendahuluanunclassified

“…Stridor pada pasien LM dipengaruhi oleh aktivitas, akan timbul ketika bayi menangis, posisi tidur telentang, saat menyusu, infeksi saluran nafas atas dan saat marah. 1,8,9 Sekitar 80% kasus laringomalasia merupakan kasus ringan dan sedang yang membaik setelah 8-12 bulan serta resolusi dan sembuh setelah 12-24 bulan, namun 10-20% dari kasus merupakan derajat berat yang mengancam nyawa dan membutuhkan tindakan operasi segera. 3,6,10 Penyebab pasti dari laringomalasia ini masih belum diketahui, namun terdapat beberapa teori yang diduga menjadi Tinjauan Pustaka patogenesis LM yaitu teori imaturitas kartilago, abnormal anatomi dan imaturitas neuromuskular.…”

Section: Pendahuluanunclassified

“…Teori lain yang menjelaskan terjadinya LM ini adalah peran dari lemahnya kontrol neuromuskular yang mengakibatkan hipotonus relatif pada otot dilator supraglotis yang mengakibatkan stuktur supraglotis akan kolaps dan tertutup. 1 Kelainan pada nervus Vagus akan mengakibatkan menurunnya tonus laring sehingga terjadi kolaps struktur laring dan gangguan mekanisme menelan yang memicu obstuksi jalan nafas dan gangguan menelan. Hal ini terjadi akibat tidak berkembangnya sistem saraf pusat , terutama nervus perifer dan batang otak yang berperan dalam mengontrol pernafasan dan menjaga patensi jalan nafas.…”

Section: Imaturitas Neuromuskularunclassified

“…Pembagian derajat ini berdasarkan terdapat atau tidaknya gejala yang berhubungan dengan gangguan dalam menelan makanan serta gejala obstruktif saluran nafas atas. 1,4,10 Laringomalasia derajat ringan terdapat stridor inpirasi dan gejala yang berhubungan dengan gangguan dalam menelan saat pasien makan seperti batuk, tersedak dan regurgitasi. Obstruksi saluran nafas pasien derajat ringan tidak akan menyebabkan hipoksia, saturasi oksigen berkisar antara 98-100%.…”

Section: Klasifikasi Laringomalasiaunclassified

“…Laringomalasia derajat sedang terdapat stridor inspirasi yang semakin jelas dan gejala saluran nafas yang berhubungan dengan makan semakin berat, terdapat sianosis saat makan dan penurunan saturasi oksigen ≤ 96%, sekitar 40% pasien merupakan LM derajat sedang. 1,4,10 Pasien LM derajat berat mempunyai 8 tanda primer, yaitu: 1.stridor inspirasi, 2.retraksi suprasternal, 3.retraksi substernal, 4.kesulitan dalam makan, 5.tersedak, 6.muntah setelah makan, 7.gangguan tumbuh kembang dan 8.sianosis. Pasien akan mempunyai saturasi oksigen ≤ 86% (tabel 1).…”

Section: Klasifikasi Laringomalasiaunclassified

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Diagnosis dan Penatalaksanaan Laringomalasia

Elfianto

Novialdi

2018

JKA

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AbstrakLatar belakang: Laringomalasia (LM) merupakan penyebab tersering stridor inspirasi kongenital pada bayi. Sekitar 80% kasus merupakan derajat ringan dan sedang yang dapat membaik serta resolusi sampai usia 2 tahun sedangkan 20% merupakan derajat berat yang membutuhkan tindakan pembedahan Tujuan: Mengetahui dan memahami etiologi, diagnosis dan penatalaksanaan laringomalasia. Tinjauan Pustaka: Diagnosis laringomalasia dapat ditegakkan dari anamnesis, pemeriksaan fisik serta pemeriksaan penunjang laringoskopi serat optic fleksibel. Etiologi pasti laringomalasia belum diketahui, namun terdapat 3 teori yang diduga berperan yaitu imaturitas kartilago, imaturitas neuromuskular dan abnormalitas anatomi. Terdapat hubungan antara laringomalasia dengan laryngopharyngeal reflux (LPR). Penatalaksanaan konservatif dilakukan pada LM derajat ringan dan sedang sedangkan tindakan pembedahan dilakukan pada derajat berat, laringomalasia dengan komorbid dan laringomalasia yang gagal terapi konservatif. Kesimpulan: Laringomalasia merupakan kolapsnya struktur supraglotis ketika inspirasi yang mengakibatkan adanya stridor inspirasi. Laringomalasia derajat berat dapat mengancam nyawa. Sebagian besar kasus akan resolusi sendiri, namun sekitar 20% memerlukan tindakan pembedahan. Supraglottoplasti merupakan tindakan pembedahan pilihan untuk kasus laringomalasia Kata kunci: Laringomalasia, stridor inspirasi, laringoskopi serat optik fleksibel, supraglottoplasti AbstractBackground : Laryngomalacia (LM) is the most common cause of inspiration stridor in infant. About 80% cases are mild and moderate that can improvement and resolution by 2 years of age, and aboout 20% cases is severe that need surgical intervention. Objective : Knowing and understanding etiology, diagnosis and management of laryngomalacia. Literature review :. Diagnosis of laryngomalacia is obtained from the history, phisical examination and supporting examination such as flexible fibreoptic laryngoscopy (FFL) . The etiology was unknown, but there are some theory that can explain cause of laryngomalacia such as cartilage immaturity, neuromuscular immaturity, an anatomic abnormality. There is corelation between laryngomalacia and laryngopharingeal reflux disease (LPR). Conservative treatment choosing for mild and moderate laryngomalacia and surgical intervention perform for severe laryngomalacia, laryngomalacia with comorbid disease and laryngomalacia which failed with conservative treatment. Conclusion : Laryngomalacia is a condition of supraglottic structure collaps into the airway during inspiratory phase that produce inspiration stridor and can make life threatening. Most of the cases are self limiting resolution, only about 20% need surgical intervention. Supraglottoplasty is the choice surgical procedure for laryngomalacia.

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Section: Pendahuluanunclassified

Section: Imaturitas Neuromuskularunclassified

Section: Klasifikasi Laringomalasiaunclassified

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Diagnosis dan Penatalaksanaan Laringomalasia

Elfianto

Novialdi

2018

JKA

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Etiology, Clinical Profile, Evaluation, and Management of Stridor in Children

et al. 2021

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Objective To evaluate various causes of pediatric stridor and their management among admitted patients in last 2 y. Methods Retrospective study of 67 stridor cases in pediatric age group (from birth to 18 y), admitted to the Department of Pediatrics and ENT (Ear, Nose and Throat) from May 2018 to April 2020 were included in the study. Data were obtained from medical records regarding age, gender, clinical presentation, and management. Results Out of 67 cases of pediatric stridor, 28.3% were infants, 50.7% were between 1 to 5 y, while 20.9% were between 5 to 18 y. Foreign body trachea (FB) was the most common (38.8%) cause of stridor. The commonest cause of stridor among infants was laryngomalacia (47.4%) while FB trachea (55.9%) was the commonest cause among 1 to 5 y age group. In age group between 5 to 18 y, peritonsillar abscess and bacterial tracheitis (21.4% each) were found to be the most common. Primary management with securing of airways were done in all cases. Curative treatment was provided according to the underlying pathology. Eight patients (11.9%) required tracheostomy to bypass airway obstruction. There was no mortality in the present study population. Conclusion Pediatric stridor management is a teamwork between ENT surgeons, pediatricians, and anaesthetists. Management starts with suspicion from history followed by clinical and radiological evaluation. Securing airway is of utmost importance and precise management of cause is carried out later.

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Impact of Infant Supraglottoplasty on Quality of Life

Vandjelovic

Brown

Traboulsi

et al. 2018

Otolaryngol.--head neck surg.

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Objectives The objective of the present study is to examine the impact of supraglottoplasty on the quality of life (QOL) of caregivers and infants with severe laryngomalacia and moderate laryngomalacia with feeding difficulties. Study Design Prospective cohort study. Setting Tertiary children's hospital. Subjects and Methods Thirty-nine infants who underwent supraglottoplasty were examined. The primary caregiver answered the 47-item short form of the Infant and Toddler Quality of Life Questionnaire-47 pre- and postoperatively; the subsection scores were compared. A 1-way analysis of variance was performed to analyze the effect of age and sex. A comparison was made between our cohort and a general population of healthy children. Results The average age at surgery was 4.0 months, and 53% of the patients were male. There was significant postoperative improvement in overall health, physical ability, growth and development, bodily pain, temperament, emotional impact on the caregiver, impact on caregiver's time, and family cohesion scores ( P < .05). The same subscale scores remained significantly improved postoperatively after age and sex were controlled. Preoperative QOL scores were significantly worse than those of the general population in nearly all categories. Postoperative physical ability ( P = .009) and temperament ( P = .011) QOL scores were higher than the those of the general population. Scores for growth and development ( P = .132), bodily pain ( P = .481), and family cohesion ( P = .717) were equivalent to those of the general population. Conclusion QOL was significantly improved after supraglottoplasty for infants with severe laryngomalacia and moderate laryngomalacia with feeding difficulties. After supraglottoplasty, QOL was similar to that of the general infant population in most categories.

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Laryngomalacia: Diagnosis and management

Cited by 7 publications

References 32 publications

Diagnosis dan Penatalaksanaan Laringomalasia

Diagnosis dan Penatalaksanaan Laringomalasia

Etiology, Clinical Profile, Evaluation, and Management of Stridor in Children

Impact of Infant Supraglottoplasty on Quality of Life

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