Laryngomalacia: factors that influence disease severity and outcomes of management

Thompson, Dana M.

doi:10.1097/moo.0b013e3283405e48

Cited by 132 publications

(158 citation statements)

References 41 publications

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“…In our series, the patient with Smith-Magenis syndrome (patient 1) presented with a massively overhanging epiglottis. According to Landry et al [16], this type of laryngomalacia is more often observed in infants with severe forms and this condition seems challenging to treat, epiglottopexy being of limited success [26].…”

Section: Discussionmentioning

confidence: 99%

Management of laryngomalacia in children with congenital syndrome: The role of supraglottoplasty

Escher

Probst

Gysin

2015

Journal of Pediatric Surgery

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BACKGROUND/IMPORTANCE: Supraglottoplasty is the surgical procedure of choice for severe laryngomalacia and has shown to be successful in most cases; however, patients with medical comorbidities present a higher rate of failure. To date, the best management of laryngomalacia in children with congenital syndrome remains unclear. PURPOSE: To study the outcome of supraglottoplasty in children with severe laryngomalacia, and to analyze the management and outcome in infants with a congenital syndrome. METHODS: Retrospective medical records review from January 2003 to October 2012 of all patients who underwent laser supraglottoplasty for severe laryngomalacia at the University Children's Hospital Zurich, Switzerland. RESULTS: Thirty-one patients were included; median age at time of surgery was 3.5 months. Three patients (10%) had a genetically proven congenital syndrome with associated neurologic anomalies. Overall success rate was 87%. Failures were observed in four (13%) of 31 cases; including all three patients presenting a congenital syndrome. CONCLUSIONS: Supraglottoplasty is an effective and safe treatment for laryngomalacia in otherwise healthy children. Signs of a possible underlying predominant neurologic origin and discrepancy between the clinical presentation and the endoscopic findings have to be taken into account, as in children with congenital syndrome with neurologic anomalies the risk of failure is higher.

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Section: Discussionmentioning

confidence: 99%

Management of laryngomalacia in children with congenital syndrome: The role of supraglottoplasty

Escher

Probst

Gysin

2015

Journal of Pediatric Surgery

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“…Thompson (21) stated that severe laryngomalacia could be mentioned in the presence of inspiratory stridor accompanied with cyanosis and apnea, oxygen saturation level of 86% and lower at rest, recurrent aspirations, and growth-developmental retardation. Furthermore, they emphasized that these patients were candidates for surgery.…”

Section: Discussionmentioning

confidence: 99%

Laryngomalacia: Our Clinical Experience

Olgun

Özay

Çakır

et al. 2017

Turk Arch Otorhinolaryngol

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Objective: The aim of this study is to analyse the clinical symptoms, follow-up and treatment properties of the laryngomalacia patients that we encountered between 2009 and 2014. Methods:Records of 81 laryngomalacia patients who were followed up in our clinic between 2009 and 2014 were retrospectively analysed. Patients' gender, age, time of onset of the symptoms, chief complaints, other co-existing congenital laryngeal anomalies and treatment and follow-up properties were evaluated. Results:Of the 81 patients, 48 were male and 33 were female, and the mean age was 4.9 months. The average period of follow-up was 12.1 months. The chief complaints at the time of admission were stridor (100%) and episodic cyanosis with feeding (27.16%). Symptoms of 75 patients were resolved at an average of 8.2 months with conservative treatment. Three patients underwent supraglottoplasty. Tracheotomy and posterior cordotomy was performed for a patient with co-existing vocal cord paralysis. Additional tracheotomy was necessary for a patient with pulmonary co-morbidities and for another with co-existing subglottic stenosis. Conclusion:Laryngomalacia is the most common cause of stridor in infants. The majority of laryngomalacia patients can be managed conservatively by close follow-up. For patients in whom respiratory and feeding problems persist or growth retardation develops, surgical treatment is performed. Tracheotomy may be necessary for a small group of patients with additional diseases.

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“…1, Video 1). Abnormal neuromuscular tone of the supraglottic larynx is the prevailing theory for the etiology of LM [8]. Infants with LM usually present at the age of 1-6 months with inspiratory stridor since birth or shortly thereafter that worsens with feeding, agitation, or supine positioning.…”

Section: Treatment Congenital Laryngomalaciamentioning

confidence: 99%

“…Ten to 20 % of children presenting with LM will require surgical intervention for severe airway obstruction resulting in apneas, blue spells, feeding difficulties, and failure to thrive, while others may be treated conservatively with medical management of reflux and close observation [8,10]. These patients undergo intraoperative microlaryngoscopy with bronchoscopy and demonstrate evidence of supralaryngeal prolapse upon inspiration (Video 2).…”

Section: Treatment Congenital Laryngomalaciamentioning

confidence: 99%

“…Double-stage LTP is often recommended for patients with more severe stenosis or significant medical comorbidities, such as underlying pulmonary or neurologic disease that may complicate extubation or dependence on a newly reconstructed airway [8,21]. In double-stage LTP, the tracheotomy tube is left in place at the time and a Teflon-coated or silastic stent is used to support the cartilage grafts.…”

Section: % Of Intubated Neonates [3•• 7 8 14••]mentioning

confidence: 99%

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