Endoscopic supraglottoplasty in children with severe laryngomalacia with and without neurological impairment

Abstract

Objective: to describe indications and results of supraglottoplasty for severe laryngomalacia in children with or without neurological impairment. Methods: eight children with severe laryngomalacia submitted to endoscopic supraglottoplasty were retrospectively studied. Four had neurological impairment (male, mean age 6 years), and 4 did not present neurological problems (3 female, mean age 11.5 months). Surgery indications were respiratory distress, feeding difficulties, failure to thrive, and low oxygen saturation. Polysomnographic evaluation was carried out on the last 2 children, showing abnormal oxygen saturation, obstructive apnea, and hypoventilation. All children received preoperative antibiotics and corticosteroids. Results: all children without neurological impairment had significant relief of symptoms. Children with neurological impairment had different outcome: one needed tracheotomy immediately after surgery due to edema and supraglottic granulation tissue. The other three children presented initial relief of symptoms, but subsequent follow-up showed progressive airway obstruction: one needed another endoscopic surgery 6 months later; other needed tracheotomy 7 months later. The children who were not submitted to tracheostomy presented persistent severe airway obstruction. No endoscopic surgery complication was observed. Conclusions: 1) Endoscopic supraglottoplasty is well tolerated and does not present complications when used in children; 2) Endoscopic supraglottoplasty was efficient in the treatment of children with severe laryngomalacia and in without neurological impairment; however, supraglottoplasty did not resolve airway obstruction in children with neurological impairment.

Objective assessment of supraglottoplasty outcomes using polysomnography

“…These observations have been primarily in children undergoing adenotonsillectomy for obstructive sleep apnoea syndrome. Fraga et al observed a poorer outcome of supraglottoplasty for laryngomalacia in a group of 8 patients; 4 of which had underlying neurological impairment [15]. Two patients in our study group (Patients 4 and 6) had a comorbidity associated with hypotonia; both patients had Downs' Syndrome.…”

Supraglottoplasty outcomes in relation to age and comorbid conditions

“…In our study, patients with a neurologic comorbidity presented and were diagnosed at a later age, underwent surgery at a later age, and ultimately 60% underwent tracheostomy after failed supraglottoplasty. Fraga et al compared children without and with neurological impairment (all with cerebral palsy): those without all did well, but 50% of those with CP required tracheostomy, and the other 50% had persistence of symptoms [11]. Thompson reports that 5/5 patients that required tracheostomy after failed supraglottoplasty had GERD and a neurologic diagnosis [4].…”

Evaluation of the Efficacy of Supraglottoplasty in Obstructive Sleep Apnea Syndrome Associated With Severe Laryngomalacia

“…According to the literature, the most common associated alterations are airway and neurologic malformations. 4,11,12,15,19 Some authors advocate the use of bronchoscopy in all children with LM to determine possible associated airway malformations. We, as well as Onley et al, 20 believe that this procedure should be performed only in children who have more severe symptoms or whose symptoms are incompatible with the endoscopic findings.…”