Success of supraglottoplasty for severe laryngomalacia: The experience from Northeastern Ontario, Canada

Hwang, Euna; Chung, Jeffson; MacCormick, Johnna; Bromwich, Matthew; Vaccani, Jean‐Philippe

doi:10.1016/j.ijporl.2013.04.010

Cited by 14 publications

(9 citation statements)

References 11 publications

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“…Most of our patients (77.3 %) were operated with CO 2 laser, with superpulse mode, which is comparable with other authors [ 8 , 29 ]. Superpulse mode allows the tissue to cool down between two impulses, therefore minimizing tissue damage.…”

Section: Discussionsupporting

confidence: 91%

“…Hoff et al described a higher rate of revision supraglottoplasty (15.2 vs. 47.8 %) and tracheostomy depending on the presence of comorbidity (0 vs. 39.1 %) [ 8 ]. Other studies showed a range of 4.4–34.6 % of patients required either revision supraglottoplasty or tracheostomy after primary supraglottoplasty [ 12 , 29 , 30 ]. Although complications are rare [ 31 ], supraglottic stenosis is a known complication of supraglottoplasty with a reported incidence of 3.7 % [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

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Treatment outcome of supraglottoplasty vs. wait-and-see policy in patients with laryngomalacia

Heijden

Dikkers

Halmos

2016

Eur Arch Otorhinolaryngol

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In most cases, laryngomalacia presents as a mild disease, and the symptoms resolve after wait-and-see policy. Up to 20 % of patients present with severe laryngomalacia and may require surgery (i.e. supraglottoplasty); however, the indication for surgery is not firmly established yet. The goal of this study is to determine whether supraglottoplasty results in a better outcome than wait-and-see and to investigate how different comorbidities influence outcome. A retrospective study of pediatric cases of in a tertiary referral center was performed. Photo and video documentation was available and revised in all cases. Electronic and paper charts were reviewed for the following variables: gender, sex, gestational age, birth weight, symptoms, comorbidity, date of endoscopy, severity and type of laryngomalacia, treatment modality and technique and follow-up data and a total 89 patients were included. Supraglottoplasty was found to lead to significantly faster complete improvement of laryngomalacia than wait-and-see policy (5 weeks vs. 29, p = 0.026). Synchronous airway lesions (SALs) were present in 40.4 % of patients and were associated with prolonged symptoms of laryngomalacia (38.5 weeks vs. 14.5, p = 0.043). Supraglottoplasty is safe and effective in treatment of severe laryngomalacia. SALs and comorbidities are frequently found in patients with laryngomalacia and are responsible for longer onset of complaints.Electronic supplementary materialThe online version of this article (doi:10.1007/s00405-016-3943-3) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Treatment outcome of supraglottoplasty vs. wait-and-see policy in patients with laryngomalacia

Heijden

Dikkers

Halmos

2016

Eur Arch Otorhinolaryngol

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“…Forty‐four studies were excluded for the following reasons: the number of patients undergoing polysomnography pre‐ and postsupraglottoplasty was not provided; no quantitative data for polysomnograms was provided; only adults were included; procedure(s) were performed in addition to the supraglottoplasty with no stratification of data for those who underwent isolated supraglottplasty; only preoperative data was available; some children were sedated with choral hydrate; the postoperative data was only available for a fraction of patients; portable pulse‐oximetry was used instead of formal polysomnography; or they were review articles …”

Section: Resultsmentioning

confidence: 99%

“…Forty-four studies were excluded for the following reasons: the number of patients undergoing polysomnography pre-and postsupraglottoplasty was not provided 43 ; no quantitative data for polysomnograms was provided 12,18,21,22,[24][25][26]28,29,[32][33][34][35][36][37][38][39]41,42,[44][45][46]49,51,53,54,56,58,61,64,66 ; only adults were included 19 ; procedure(s) were performed in addition to the supraglottoplasty with no stratification of data for those who underwent isolated supraglottplasty 27,50,63 ; only preoperative data was available 55 ; some children were sedated with choral hydrate 47 ; the postoperative data was only available for a fraction of patients 30 ; portable pulse-oximetry was used instead of formal polysomnography 31 ; or they were review articles. 40,52,62 Overall, there were a total of 138 patients (ages 1 month-12.6 years) with quantitative polysomnographic data who underwent isolated supraglottoplasty.…”

Section: Resultsmentioning

confidence: 99%

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Supraglottoplasty for laryngomalacia with obstructive sleep apnea: A systematic review and meta‐analysis

et al. 2015

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Objectives/Hypothesis: To determine if apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) improve following isolated supraglottoplasty for laryngomalacia with obstructive sleep apnea (OSA) in children.Study Design: Systematic review and meta-analysis. Methods: Nine databases, including PubMed/MEDLINE, were searched through September 30, 2015.Results: A total of 517 studies were screened; 57 were reviewed; and 13 met criteria. One hundred thirty-eight patients were included (age range: 1 month-12.6 years). Sixty-four patients had sleep exclusive laryngomalacia, and in these patients: 1) AHI decreased from a mean (M) 6 standard deviation (SD) of 14.0 6 16.5 (95% confidence interval [CI] 10.0, 18.0) to 3.3 6 4.0 (95% CI 2.4, 4.4) events/hour (relative reduction: 76.4% [95% CI 53.6, 106.4]); 2) LSAT improved from a M 6 SD of 84.8 6 8.4% (95% CI 82.8, 86.8) to 87.6 6 4.4% (95% CI 86.6, 88.8); 3) standardized mean differences (SMD) demonstrated a small effect for LSAT and a large effect for AHI; and 4) cure (AHI < 1 event/hour) was 10.5% (19 patients with individual data). Seventy-four patients had congenital laryngomalacia, and in these patients: 1) AHI decreased from a M 6 SD of 20.4 6 23.9 (95% CI 12.8, 28.0) to 4.0 6 4.5 (95% CI 2.6, 5.4) events/hour (relative reduction: 80.4% [95% CI 46.6, 107.4]); 2) LSAT improved from a M 6 SD of 74.5 6 11.9% (95% CI 70.9, 78.1) to 88.4 6 6.6% (95% CI 86.4, 90.4); 3) SMD demonstrated a large effect for both AHI and LSAT; and 4) cure was 26.5% (38 patients with individual data).Conclusion: Supraglottoplasty has improved AHI and LSAT in children with OSA and either sleep exclusive laryngomalacia or congenital laryngomalacia; however, the majority of them are not cured.

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Evaluation and Management of the Pediatric Airway

Truong¹,

Messner²

2015

Cummings Pediatric Otolaryngology

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Success of supraglottoplasty for severe laryngomalacia: The experience from Northeastern Ontario, Canada

Cited by 14 publications

References 11 publications

Treatment outcome of supraglottoplasty vs. wait-and-see policy in patients with laryngomalacia

Treatment outcome of supraglottoplasty vs. wait-and-see policy in patients with laryngomalacia

Supraglottoplasty for laryngomalacia with obstructive sleep apnea: A systematic review and meta‐analysis

Evaluation and Management of the Pediatric Airway

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