Transcervical Epiglottopexy for the Management of Type 3 Laryngomalacia

Abstract

Type 3 laryngomalacia (LM) is characterized by prolapse of the epiglottis into the airway. Endolaryngeal suturing is technically challenging considering the limited exposure. In the present article, we describe a simple technique of transcervical epiglottopexy (TE) via an exo-endolaryngeal technique using an 18-G needle prethreaded with a 2-0 Prolene suture in a looped fashion inserted through the inferior epiglottis. Another 20-G needle with a 2-0 Prolene suture with one free end is inserted above the previous stitch through the superior epiglottis. The single stitch is passed through the looped stitch, which is then pulled through the neck, leaving a single stitch precisely placed through the epiglottis. We have used this technique safely while achieving epiglottopexy in 3 cases of epiglottic prolapse. We describe a method of TE using easily available instruments. This method we believe can easily be adapted for any kind of epiglottic prolapse.

Transcervical Epiglottopexy: A versatile technique for managing epiglottic prolapse

“…However, no new aspiration or penetration was noticed in patients with pre‐ and postoperative swallowing studies. This was in alliance with what has been observed in previous studies 4,14,15 …”

“…Although various surgical approaches have been described for the management of pediatric EP, no study has demonstrated the superiority of 1 technique over the other 1‐6 . In the present study, we describe surgical outcomes in a cohort of patients undergoing a novel technique of TCE.…”

“…We have previously described the surgical technique in detail. 4 The technique is explained in the schematic (Figure 2) as well as described in the surgical video (Video 1). After suspension laryngoscopy, demucosalization is achieved either with the aid of a flexible fiber CO 2 laser (7-8 W in repeat mode) or using coablation using the Procise max wand (Smith and Nephew).…”

“…1 Various techniques have been described for epiglottopexy, including the use of coblation or laser for demucosalization of the lingual surface of the epiglottis and tongue base followed by an endolaryngeal anchoring stitch between the epiglottis and the tongue base. [1][2][3][4][5] Although endolaryngeal suturing is a viable option in older children; in infants, endolaryngeal suturing is not only technically challenging, considering the limited exposure which severely constraints instrumental manipulation but can also be associated with stitch breakdown due to the inability to achieve sufficient depth through the tongue base. Endolaryngeal suturing can also be timeconsuming due to this enhanced technical difficulty.…”

Video_1.MP4

“…The ultrasound guided exo-endolaryngeal technique of suture lateralization has been previously described by our team for the management of bilateral vocal cord paralysis (5). We have also used the exoendolaryngeal lasso technique for epiglottopexy for management of epiglottic prolapse (7). The technique is easy to perform and can be achieved by regular surgical needles without the need of specialized equipment.…”