Pharyngomalacia diagnosed by laryngo‐tracheo‐bronchoscopy in the neonatal intensive care unit

Abstract

Background: Flexible fiber-optic laryngo-tracheo-bronchoscopy has become widely performed in infants and neonates since the introduction of thin flexible fiberscopes. Laryngomalacia is the most common airway disease in infants causing stridor. Pharyngomalacia, termed pharyngeal occlusion during inspiration, was the second most common airway disease found in our hospital in patients that underwent laryngo-tracheo-bronchoscopy, but the incidence, patient characteristics, and natural course have not been reported in large numbers in Japan. Methods: A retrospective review was performed of medical records on patients admitted to our neonatal intensive care unit during the neonatal period diagnosed with pharyngomalacia between April 2009 and November 2018. Patient characteristics, concurrent airway diseases, comorbidities, and treatment were reviewed. Results: Forty-eight patients were diagnosed with pharyngomalacia. The median gestational age was 37.1 weeks, and the median birthweight was 2,552 g. Patients were diagnosed at a median age of 29 days, and cure was achieved at a median age of 4 months. Twenty-eight patients had concurrent airway diseases, laryngomalacia being the most common. Continuous positive airway pressure or high flow nasal cannula was used in 34 patients. Conclusions: In patients with pharyngomalacia, half were born preterm, and more than half had concurrent airway diseases. The onset and diagnosis were made within the first month of life in more than half of the patients, and resolution was seen mostly within the first 6 months of life. Whenever a patient is suspected of having an airway disease, the pharyngeal space should be carefully observed to diagnose pharyngomalacia.

A neonatal case of an elongated soft palate

“…Although all such cases had chromosomal or genetic abnormalities, the present baby had no obvious malformation, and there were no other findings that would raise suspicion of genetic abnormalities. Patients with functional abnormalities of the pharynx or larynx may have feeding difficulties as well as stridor and hypoxemia 3) , but the present baby had no feeding problems and was gaining weight well. Furthermore, including those of “elongated uvula”, most past cases were reported to have been treated surgically (e.g., with uvulopalatopharyngoplasty) 4 , 5) .…”

“…Uvulopalatopharyngoplasty is a surgical procedure to excise the uvula and soft palate and to resect a substantial amount of tissue from the lateral pharyngeal walls 6) . Fortunately, our patient improved with high PEEP therapy as a conservative treatment, which is a commonly used treatment for upper airway obstructive diseases 3,7) .…”