Supraglottoplasty Outcomes in Neurologically Affected and Syndromic Children

Abstract

Supraglottoplasty remains useful and outcomes were better in patients with neurologic comorbidity than in patients with syndromic comorbidity.

Laryngomalacia: Review and Summary of Current Clinical Practice in 2015

“…In a recent systematic review of 8 studies reporting surgical outcomes after supraglottoplasty, Preciado and Zalzal reported a higher risk ratio of surgical failure (7.14) in children with comorbidities such as neurologic and cardiac disease or severe GERD compared to those with isolated disease [44]. Persistent respiratory or feeding difficulties have also been reported in [11], especially in premature or neurologically affected children [45,46] with an increased risk ratio for persistent or significant aspiration of 4.3 in children with co-morbidities [44]. Other surgical complications such as airway stenosis, granuloma formation, or airway fires have been rarely reported as well [37].…”

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.…”

The Infant With Noisy Breathing

“…1). Carbon dioxide (CO 2 ) laser and cold steel instruments have both been used with a success rate of up to 90 % [4••]; however, outcomes are less favorable in syndromic children and those with medical comorbidities such as neurologic disease [1,6]. The risk of complications in skilled hands is very low [1].…”

“…One should ask the parent if the infant is having retractions, apneas, or cyanosis and whether the noisy breathing gets better or worse with positioning. Supine positioning often worsens symptoms of laryngomalacia [3••, 4••, 5,6] but will have very little effect on symptoms secondary to nasal or pharyngeal obstruction. Inquiry into, and mimicking, the sounds of stertor and stridor will improve a parent's ability to provide historic detail on their child's airway problem.…”