Aryepiglottoplasty for laryngomalacia: the Alder Hey experience

Abstract

Laryngomalacia is the most common cause of stridor in infants. Severely affected children are at risk of feeding difficulties, apnoeic episodes and cor pulmonale secondary to upper airway obstruction. The aim of this study was to assess the outcome of aryepiglottoplasty. This is a simple surgical procedure that relieves the obstruction by dividing the aryepiglottic folds. Thirty children had an aryepiglottoplasty at the Royal Liverpool Children's Hospital between January 1995 and June 2001. The case notes of all 30 children were reviewed for age, sex, age at operation, indications, operative technique, complications and long-term outcomes. Complete resolution of stridor was obtained in 83 per cent of patients, with an improvement in a further 7 per cent. Post-operative complications included lower respiratory tract infections (13 per cent) and vomiting (7 per cent). In conclusion, simple endoscopic aryepiglottoplasty remains an effective way of treating upper airway obstruction in children. Its high resolution and low complication rate make it a safe, first choice procedure for treatment of moderate to severe laryngomalacia.

Role of transoral CO2 laser surgery for severe pediatric laryngomalacia

“…This is comparable to other studies adopting similar conservative surgical methods [24]. Martin et al [25] had similar results with complete resolution of stridor in 83%. There were no instances of supraglottic stenosis, granulation tissue formation or infection.…”

Management of pulmonary hypertension in Down syndrome

“…The mainstay of management of lower airways disease is the use of prophylactic antibiotics and regular inhaled corticosteroids, alongside oxygen and physiotherapy [4]. Adenotonsillectomy may be beneficial in those patients with significant airways obstruction [4], and children with severe laryngo-tracheo-bronchomalacia may require treatment with home oxygen therapy, with or without CPAP [4], or even aryepiglottoplasty [11].…”

“…Patients with DS are also known to be susceptible to malacic airways, in particular, laryngomalacia [5,13]. There is increased incidence of gastro-oesophageal reflux, which may worsen airway disease [11]. Upper airway obstruction with repeated episodes of systemic hypoxaemia is associated with the development of increased pulmonary vascular resistance and may contribute to the more rapid development of PAH in children with DS and left-to-right shunts, leading to irreversible pulmonary vascular disease.…”

Atypical Presentation of Severe Laryngomalacia Managed with Aryepiglottoplasty and A Novel Suture Technique

“…Surgical management of laryngomalacia is indicated only in severe cases, and aryepiglottoplasty is the surgical treatment of choice [16] . There was no history of any trauma, foreign body ingestion, asthma or mechanical ventilation.…”