Vallecular cyst with coexisting laryngomalacia: Successful diagnosis and laser therapy by flexible endoscopy with a novel noninvasive ventilation support in infants

Abstract

Objective Vallecular cyst coexisting with laryngomalacia (VC‐LM) can cause significant pharyngolaryngeal obstruction. Traditionally, it is diagnosed with flexible endoscopy (FE) and treated by rigid endoscopy. This study evaluates the effectiveness of solely using FE with novel noninvasive ventilation (NIV) of sustained pharyngeal inflation (SPI) support for both diagnosis and treatment in such infants. Methods A retrospective review of consecutive infants who were diagnosed and treated for VC‐LM in the 12‐year period, 2007 to 2018, was conducted. Clinical variables, techniques, and outcomes were analyzed and reported. Results Eighteen infants (10 males) were included. The mean age was 3.0 ± 0.6 months and the mean body weight was 4.6 ± 1.3 kg. Before FE, 14 infants were supported with bi‐nasal prongs NIV (BN‐NIV) and four infants with tracheal intubation. During diagnostic and therapeutic FE, all infants supported with a nasopharyngeal NIV (NP‐NIV) only. All diagnoses were made in the first FE inspection of 3.5 ± 1.2 minutes. Thirteen lesions were immediately treated with FE laser therapy in 18.1 ± 1.7 minutes in the same FE course. Total FE time was 24.6 ± 2.8 minutes. Three infants needed revision laser therapy 4 days later. There was no desaturation (<90%), bradycardia (<100/min), or pneumothorax. After FE therapy, all infants were supported with BN‐NIV only with significantly (<0.01) lower pressure and completely weaned off before being discharged 8.4 ± 1.5 days later. All infants, followed up for a 6‐month period, showed many clinical improvements. Conclusions FE, with this NP‐NIV and SPI supports, could offer accurate diagnosis and successful laser therapy of the VC‐LM with procedural sedation in the same session in infants.

Sustained pharyngeal inflation on upper airway effects in children—Flexible bronchoscopy measurement

“…Furthermore, dynamic pressures of SPI may also facilitate tracheobronchial lumen expansion and lung ventilation. For patients with risk of compromised airway and oxygen desaturation, this technique may reduce hypoxia, and improve patient safety 9–15,19–21 …”

Sustained pharyngeal inflation on upper airway effects in infants---flexible bronchoscopy measurement

“…This is not only safe for the patient, but also assists for the therapeutic intervention of FB such as doing laser partial adenoidectomy and tonsillectomy, check bleeding, marsupialization of vallecular cyst, 11 epiglottoplasty, 16 etc. Our team has already been using this SPI modality successfully in many pediatric endoscopy interventions of airway [9][10][11][12][13][14][15][16] and esophagus. 17,18 Physiologically, this PhO 2 -NC has combinational effects of "apnea oxygenation" [19][20][21][22][23] and PPV.…”

“…It has already been demonstrated to provide adequate oxygenation and ventilation to assist interventional flexible bronchoscopy (FB) in pediatric patients, even in hypoxemic children on respiratory support. [9][10][11][12][13][14][15] A prolonged duration of the action of NC indeed mimic an SPI. Theoretically, in a relatively close space like the PLS, with the setting of a continuous PhO 2 flow, the ventilation effect of the SPI may create as well as increase the PIP in the PLS.…”

Sustained pharyngeal inflation with oxygen tube effects on upper airway pressure and lumen changes in infants---flexible bronchoscopy measurement

“…Which also benefits for the therapeutic intervention of FB such as doing laser partial adenoidectomy and tonsillectomy, check bleeding, marsupialization of vallecular cyst, 11 epiglottoplasty, 16 etc. We have already applied this SPI modality successfully in many pediatric endoscopy interventions of airway [9][10][11][12][13][14][15][16] and esophagus. 17,18 Physiologically, this PhO 2 -NC has combinational effects of "apnea oxygenation" [19][20][21][22][23] and PPV.…”

“…Which has already demonstrated able to provides adequate oxygenation and ventilation to assist interventional flexible bronchoscopy (FB) in children, even in severe asphyxiated status. [9][10][11][12][13][14][15] In the setting of PhO 2 , the ventilation effect of the "nose-close (NC)" can also create PIP in the PLS. A prolonged duration of the NC indeed provides a SPI.…”