Laser supraglottoplasty for laryngomalacia: are specific anatomical defects more influential than associated anomalies on outcome?

O tratamento da laringomalácia: experiência em 22 casos

“…We decided to use a pro-kinetic agent (bromopride) as a routine, because many studies [11][12][13][14][15][16][17] have already demonstrated the association between laryngomalacia and gastroesophageal reflux. Bibi 18 and Yellon 19 found this association in 70% and 75% of the cases, respectively.…”

“…Some authors suggest unilateral section of aryepiglottic fold 17,[23][24][25] with good results, but about 15% of the patients still require contralateral procedure.…”

Does Reflux Have a Causative Role in Laryngomalacia?

“…Central neurologic abnormalities are a common coexistent finding in children with laryngomalacia [10]; cases have also been described of patients that developed an acquired form of laryngomalacia after a neurologic insult, supporting neuromuscular immaturity or dysfunction as a contributory factor in at least some cases of laryngomalacia [11]. With regards to anatomical etiologies, traditional teaching describes the "omega-shaped" epiglottis as an important factor in the development of laryngomalacia; however, in our clinical experience and of others, this configuration is often seen in unaffected infants [12], supporting the principle that laryngomalacia is not a diagnosis based on anatomical findings, but one that can only be verified upon the visual confirmation of supraglottic collapse with inspiration.…”

“…Different opinions exist regarding the definition of severe laryngomalacia and when surgical intervention is necessary; some of the more common indications used are failure to thrive, severe upper airway obstruction and frequent hospitalization [10]. Although early anectodal reports described epiglottic surgery as a successful approach to laryngomalacia, tracheostomy was the traditional surgery of choice for severe cases until Lane et al described the endoscopic excision of excess arytenoid mucosa in 1984 [19].…”

“…Either way, avoiding overaggressive removal of supraglottic tissue and preservation of an intact strip of interarytenoid mucosa are important surgical principles that can minimize the possibility of this complication. Other congenital anomalies such as Pierre-Robin sequence [22] or concurrent neurologic abnormalities [10] are also associated with a higher rate of post-operative complications after supraglottoplasty.…”