Role of transoral CO2 laser surgery for severe pediatric laryngomalacia

Abstract

Controversy exists as to the preferred treatment modality for managing refractory pediatric laryngomalacia (LM). Simultaneous bilateral procedures have been associated with supraglottic stenosis. Unilateral operations have a higher rate of secondary intervention. This prospective study was conceptualized to ascertain a preferred approach. A secondary goal was to correlate the surgical outcome with presenting symptoms and signs. Twenty-two children with severe LM met the criteria for enrollment. Bilateral CO(2) laser-assisted supraglottic laryngoplasties were performed in all cases. The procedure mainly consisted of division of the aryepiglottic fold. Nineteen (86%) patients met our defined success criteria. There were no surgical complications. Bilateral supraglottic laryngoplasty has a role in the management of severe refractory LM.

Surgical treatment of severe laryngomalacia: Six month follow up

“…Stridor, which was a very significant sign before operation, was unremarkable in the majority of patients 1 month after operation. These results extend the findings of previous reports …”

“…These results extend the findings of previous reports. 7,17 Although it is expected that children with more severe forms of LM would have a greater number of desaturation events, the number of desaturation events and degree of hypoxemia were not significantly different between LM groups in the present study. The important indicator of successful surgical treatment in the present study was significant improvement in oxygenation 6 months after operation.…”

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

“…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 …”

“…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.…”

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

“…Although its pathogenesis is not fully understood, in this condition there is collapse of supraglottic tissues during inspiration [4,5] , generating a highfrequency inspiratory stridor that is exacerbated in the supine position during feeding, agitation and crying [6][7][8] . This stridor usually appears in the first two weeks of life, with an incidence peak at around 6 months and spontaneous resolution in 90 percent of the cases by the second year of life [9,10] .…”