Efficacy and predictors of success on laryngomalacia surgery: experience from a tertiary pediatric care center in Brazil

Abstract Objectives: Laryngomalacia is the most common congenital cause of stridor; the natural history of the disease runs through to complete resolution by the age of two. Severe cases are characterized by cyanosis, hypoxia, apnea, furcular and/or subcostal retractions, aspirations, pulmonary hypertension, and failure to thrive and must undergo surgery. This study aimed to evaluate the success rates of supraglottoplasty in our hospital and evaluate the predictive factors for surgical success. Methods: Cohort study, prospectively planned. 75 patients undergoing endoscopic surgery from July 2007 to July 2016 were analyzed at the Santo Antônio Children's Hospital. The primary outcome was percentage of surgical success, defined as the absence of respiratory symptoms or presence of a mild stridor without retractions on the first post-operative month (late success). The secondary outcomes were the early surgical success (absence of respiratory symptoms or presence of a mild stridor without retractions on the first post-operative day). Results: 39 (58.2%) were male, with an average of 4.9 months. Surgical success on the first day was 80.6% (n = 54). At the end of the 1st month, surgical success was 88.6%, considering only those who completed assessment. Twenty-one (34%) presented comorbidities. Presence of comorbidities, pharyngomalacia and GERD were associated with a worse result on the 1st postoperative day, whereas, at the end of the first month, presence of comorbidities, concomitant injuries (tracheo and bronchomalacia) and pharyngomalacia were the predictive variables of surgery failure. Conclusion: Supraglottoplasty has high rates of efficacy and low morbidity. The presence of comorbidities and pharyngomalacia has shown association with a worse early and late surgical outcome. Synchronous airway lesions predict a worse surgical result at the end of the first month. GERD was associated with obstructive symptomatology only in the 1st post-operative day. Level of evidence: Level 3 of evidence, according to the "The Oxford 2011 Levels of Evidence" from Oxford Centre for Evidence-Based Medicine.

Consensus recommendations on the evaluation and treatment of laryngotracheal anomalies in infants and young children / 临床耳鼻咽喉头颈外科杂志

Infants with laryngotracheal anomalies are clinically manifested as stridor or noisy breathing, choking, hoarseness, feeding difficulties, and cyanotic spells, followed by developmental and growth retardation and other health issues; in severe cases, patients may present with severe dyspnea, which is associated with high mortality. A timely diagnosis as well as appropriate strategy for laryngotracheal anomalies is still challenging for pediatric otolaryngologists. This consensus statement, evolved from expert opinion by the members of the Pediatric Otorhinolaryngology Professional Committee of the Pediatrician Branch of the Chinese Medical Doctor Association, provides comprehensive recommendations and standardized guidance for otolaryngologists who manage infants and young children with laryngotracheal anomalies in evaluation and treatment based on symptomatology, physical and laboratory examinations.

New progress in diagnosis and treatment of congenital laryngomalacia in infants / 临床耳鼻咽喉头颈外科杂志

Congenital laryngomalacia is the most common disease causing laryngeal stridor in infants. The pathogenesis has not yet been clearly concluded. It may be related to abnormal development of laryngeal cartilage anatomical structure, neuromuscular dysfunction, gastroesophageal and laryngeal reflux disease, etc. The typical manifestations of the disease are inspiratory laryngeal stridor and feeding difficulties, which can be divided into mild, moderate and severe according to the severity of symptoms. The diagnosis is mainly based on clinical symptoms, signs and endoscopy, among which endoscopy is an important diagnostic basis. The treatment of laryngomalacia depends on the severity of symptoms. Mild and some moderate congenital laryngomalacia children can be relieved by conservative treatment, and severe and some moderate congenital laryngomalacia children should be treated by surgery. Supraglottic plasty is the main surgical method, which can effectively improve the symptoms of laryngeal stridor, dyspnea, feeding difficulties and growth retardation in most children, and the surgical effect is good.

Analysis of cases of laryngeal airway diseases in infants / 临床耳鼻咽喉头颈外科杂志

Objective:To analyze the clinical data of laryngeal airway diseases in infants and provide reference for the standardized diagnosis and treatment of the disease. Methods:From June 2022 to August 2023, analyze the clinical data of 4 cases of children with laryngeal airway diseases recently admitted to Department of Otolaryngology, Fuzhou Children's Hospital of Fujian Province, and summarize the experience and lessons of diagnosis and treatment by consulting relevant literature. Results:Three cases had symptoms such as laryngeal wheezing, dyspnea, backward growth and development, etc. After electronic laryngoscopy, the first case was diagnosed with laryngeal softening （severe, type Ⅱ）, and the angular incision was performed. While cases 2, 3 diagnosed with case 2 and 3 were diagnosed with laryngeal cyst and underwent laryngeal cyst resection. All three cases underwent low-temperature plasma surgery under visual laryngoscope, and the symptoms were relieved after operation. Case 4 was laryngeal wheezing and dyspnea after extubation under general anesthesia. The electronic laryngoscopy showeded early stage of globetic stenosis, and endoscopic pseudomembrane clamping was performed, and the postoperative symptoms were relieved. Conclusion:Infants and young children with laryngeal airway diseases should pay attention to the early symptoms and be diagnosed by electronic laryngoscopy as soon as possible. With good curative effect and few complications, low-temperature plasma surgery under visual laryngoscope is recommended. The formation of pseudomembrane under the gluteal caused by tracheal intubation causes rapid onset and rapid development. The pseudomembrane extraction by clamping is convenient and fast, with good curative effect.

The airway management and treatment of newborns with micrognathia and laryngomalacia / 临床耳鼻咽喉头颈外科杂志

Objective:To explore the perioperative airway management and treatment of newborns with micrognathia and laryngomalacia. Methods:From January to December 2022, a total of 6 newborns with micrognathia and laryngomalacia were included. Preoperative laryngoscopy revealed concomitant laryngomalacia. These micrognathia were diagnosed as Pierre Robin sequences. All patients had grade Ⅱ or higher symptoms of laryngeal obstruction and required oxygen therapy or non-invasive ventilatory support. All patients underwent simultaneous laryngomalacia surgery and mandibular distraction osteogenesis. The shortened aryepiglottic folds were ablated using a low-temperature plasma radiofrequency during the operation. Tracheal intubation was maintained for 3-5 days postoperatively. Polysomnography（PSG） and airway CT examination were performed before and 3 months after the surgery. Results:Among the 6 patients, 4 required oxygen therapy preoperatively and 2 required non-invasiveventilatory support. The mean age of patients was 40 days at surgery. The inferior alveolar nerve bundle was not damaged during the operation, and there were no signs of mandibular branch injury such as facial asymmetry after the surgery. Laryngomalacia presented as mixed type: type Ⅱ+ type Ⅲ. The maximum mandibular distraction distance was 20 mm, the minimum was 12 mm, and the mean was 16 mm. The posterior airway space increased from a preoperative average of 3.5 mm to a postoperative average of 9.5 mm. The AHI decreased from a mean of 5.65 to 0.85, and the lowest oxygen saturation increased from a mean of 78% to 95%. All patients were successfully extubated after the surgery, and symptoms of laryngeal obstruction such as hypoxia and feeding difficulties disappeared. Conclusion:Newborns with micrognathia and laryngomalacia have multi-planar airway obstruction. Simultaneous laryngomalacia surgery and mandibular distraction osteogenesis are safe and feasible, and can effectively alleviate symptoms of laryngeal obstruction such as hypoxia and feeding difficulties, while significantly improving the appearance of micrognathia.

Causas de estridor congénito / Causes of congenital stridor

INTRODUCTION. Airway abnormalities are rare but potentially fatal. Stridor is a res-piratory noise with greater predominance in the inspiratory phase. OBJECTIVE. To evaluate the etiology of stridor, determine its comorbidities and mortality. MATERIALS AND METHODS. Retrospective cross-sectional study. Population of 110 and sample of 33 data from the Medical Records of neonatal or infant patients who presented stri-dor at the Carlos Andrade Marín Specialties Hospital of Quito-Ecuador, from january 2009 to december 2020. RESULTS. The 51,51% (17; 33) of cases were men. The age of the first consultation for stridor was within the first month in 18,00% (6; 33) and 40,00% (13; 33) at 3 months. The most frequent congenital laryngeal patholo-gy was: laryngomalacia 81,82% (27; 33), followed by subglottic stenosis 9,09% (3; 33), bilateral chordal paralysis 6,06% (2; 33) and tracheal stenosis 3,03% (1; 33). The 51,51% (17; 33) presented comorbidities of causes: neurological, pulmonary and genetic among the main ones. Mortality was 18,20% (6; 33) related to the severity of comorbidities, except one secondary to tracheal stenosis. CONCLUSION. Laryn-gomalacia and subglottic stenosis were the predominant pathologies with congenital stridor. The comorbidities that occurred were neurological, pulmonary, genetic and caused mortality within 90 days after diagnosis.

INTRODUCCIÓN. Las anomalías de la vía aérea son poco frecuentes, pero potencialmente mortales. El estridor es un ruido respiratorio con mayor predominio en la fase inspiratoria. OBJETIVO. Evaluar la etiología del estridor, determinar sus comorbilidades y la mortalidad. MATERIALES Y MÉTODOS. Estudio transversal retrospectivo. Población de 110 y muestra de 33 datos de Historias Clínicas de pacientes neonatos o lactantes que presentaron estridor en el Hospital de Especialidades Carlos Andrade Marín de Quito - Ecuador, de enero 2009 a diciembre 2020. RESULTADOS. El 51,51% (17; 33) de casos fueron hombres. La edad de la primera consulta por estridor fue dentro del primer mes en el 18,00% (6; 33) y del 40,00% (13; 33) a los 3 meses. La patología congénita laríngea más frecuente fue: laringomalacia 81,82% (27; 33), seguida de estenosis subglótica 9,09% (3; 33), parálisis cordal bila-teral 6,06% (2; 33) y estenosis traqueal 3,03% (1; 33). El 51,51% (17; 33) presentaron comorbilidades de causas: neurológica, pulmonar y genética entre las principales. La mortalidad fue 18,20% (6; 33) relacionada con la severidad de las comorbilidades, excepto una secundaria a estenosis traqueal. CONCLUSIÓN. La laringomalacia y la estenosis subglótica fueron las patologías que predominaron con estridor congénito. Las comorbilidades que se presentaron fueron neurológica, pulmonar, genética y causaron mortalidad dentro de los 90 días posteriores al diagnóstico.

El niño con estridor persistente / The child with persistent stridor

El estridor es un ruido respiratorio anormal generado por obstrucción o colapso de la vía aérea laringotraqueal, de manera aguda o de evolución crónica. Existen distintas causas tanto congénitas como adquiridas capaces de producir dificultad respiratoria, que puede llegar a ser grave y con potencial riesgo vital. El diagnóstico clínico del paciente con estridor persistente debe ser complementado con un estudio endoscópico de la vía aérea y en ocasiones con imágenes, para intentar determinar el o los sitios comprometidos y posibles malformaciones asociadas. La indicación de tratamiento debe ser individualizada, considerando el estado general del paciente, las etiologías responsables, el im pacto sobre la respiración y la deglución, el pronóstico y la capacidad técnica del equipo tratante, entre otras. Las alternativas pueden incluir observación, medidas no farmacológicas, medicamentos locales o sistémicos, procedimientos endoscópicos, cirugías abiertas, o bien la instalación de una traqueostomía de manera temporal o como manejo definitivo. El objetivo de esta revisión es entregar un adecuado conocimiento de la fisiopatología y la etiopatogenia del estridor pediátrico persistente, fundamental para el correcto manejo de estos pacientes complejos, que debiera realizarse idealmente en un contexto multidisciplinario.

Stridor is an abnormal respiratory sound caused by obstruction or collapse of the laryngotracheal airway, either acutely or chronically. There are different causes, both congenital and acquired, that can produce shortness of breath which may be severe and potentially life-threatening. The clini cal diagnosis must be complemented with an endoscopic airway assessment and sometimes with imaging, to try to determine the areas involved and possible associated malformations. Treatment should be individualized, considering the patient's overall condition, stridor etiology, its impact on breathing and swallowing, prognosis, and technical capacity of the managing team, among others. Alternatives may include observation, non-pharmacological measures, local or systemic medications, endoscopic and open surgeries, or a temporary or long-term tracheostomy. A thorough understan ding of the pathophysiology and etiopathogenesis of persistent pediatric stridor is essential for the correct management of these complex patients, ideally in a multidisciplinary manner.

Indicaciones y resultados de la supraglotoplastia en pacientes pediátricos en la Fundación Hospital de la Misericordia en Bogotá, Colombia, una ciudad a 2 600 metros sobre el nivel del mar, del año 2017-2018 / Indications and results of supraglottoplasty in pediatric patients at Fundación Hospital de la Misericordia in Bogotá, Colombia, a city at 2,600 meters above sea level, years 2017-2018

La causa más común de estridor en población pediátrica es la laringomalacia. En trabajos publicados a nivel del mar se ha descrito una incidencia del 70% en pacientes con estridor. Materiales y Métodos: Realizamos un estudio retrospectivo de corte transversal de la cohorte de pacientes operados de supraglotoplastía en un hospital pediátrico de cuarto nivel en una ciudad localizada a 2600 mts de altitud entre el año 2017 - 2018. Resultados: Fueron intervenidos 44 pacientes, el 55% de los pacientes eran mujeres, con una mediana de edad de 11 meses (RIQ 11 días ­ 6 años), el 4,5% fueron diagnosticados con laringomalacia Tipo I, Tipo II 43%, 2,2% Tipo III y mixtas 29,5% según la clasificación de Olmey. La indicación quirúrgica se debió a falla del medro en 8 pacientes, Síndrome sibilante con riesgo inminente de falla respirato Trabajos ria en 17, episodio breve resuelto inexplicado (BRUE) de alto riesgo en 3 y apnea del sueño de predominio obstructivo 20 pacientes. De los 20 pacientes con síndrome de apnea del sueño se obtuvo el resultado del polisomnograma en 18 pacientes donde el promedio de Índice de apnea hipopnea fue de 30,5 con una desaturación de oxígeno máxima (Nadir) del 70%. Con respecto a la intervención quirúrgica se realizó supraglotoplastia tipo I en 5 pacientes, tipo II en 30, y en 9 tipo III. el 95% de los pacientes presentaban alguna comorbilidad y el 25% de los pacientes tenían diagnóstico de anomalías craneofaciales. En 9 pacientes con síndrome de apnea hipopnea del sueño se obtuvo un polisomnograma postoperatorio con un promedio de Índice de apnea hipopnea de 15 con un nadhir del 82,8%. Conclusión: Al analizar los datos obtenidos encontramos que los pacientes operados en altura por esta condición presentan una menor incidencia de resolución completa del SAHs, pero presentan mejoría de los síntomas durante el sueño, y la saturación de oxigeno mínima, independientemente del índice de apnea hipopnea residual

The most common cause of stridor in pediatric population is laryngomalacia. In papers published at sea level it has been describe an incidence of 70% in patients with stridor. We conducted a cross-sectional study of the cohort of patients that had undergo supraglotoplasty surgery in a fourth level pediatric hospital in a city located at an altitude of 2600 meter between 2017 - 2018. 44 patients were intervened, 4.5% of whom were diagnosed with type I laryngomalacia, 43% type II, 2.2% type III, 29.5% has more tan one type this according to Oley´s classification. The surgical indication was due to growing failure in 8 patient, inminent risk to respiratory failure in 17, high risk BRUE in 3 and severe sleep apnea in 20. Type I supraglotoplasty was performed in 5 patients , type II in 30 and in 9 type III. In 14 patients it was performed and additional procedure as dilatation of subglottic stenosis, amigdalectomy and tongue base resection. 95% of the patients had a comorbidity and 25% had a diagnosis of craniofacial anomalies. Conclusión: When analyzing the data obtained we found that patients operated at height for laryngomalacia, have a lower incidence of complete resolution of OSA, but show improvement of symptoms during sleep and minimal oxygen saturation, regardless of the residual hypopnea apnea index. The authors recommend pediatric otolaryngologists to take this difference into account when adressing a patient with laryngomalacia and other comorbidities.

Laringomalacia en pacientes con síndrome de apnea obstructiva del sueño: Reporte de casos / Laryngomalacia in patients with obstructive sleep apnea syndrome: Case report

Introducción: El síndrome de apnea obstructiva del sueño, es una patología frecuente en nuestro medio y ha cobrado gran interés por su asociación a otras enfermedades. El colapso laríngeo es causa frecuente de no mejoría (persistencia de índice de apnea-hipopnea residual elevado) tras el manejo de otros niveles de la vía aérea. Objetivo: Realizar una descripción sociodemográfica y clínica de una serie de pacientes con laringomalacia y síndrome de apnea obstructiva del sueño. Diseño: Estudio de serie de casos. Métodos: Se realiza un reporte de casos de una serie de pacientes manejados en el Hospital Militar Central y Clínica Universitaria Hospital San Rafael de Bogotá, con síndrome de apnea obstructiva del sueño y laringomalacia a quienes se les realizó supraglotoplastia, entre los años 2015 - 2017. Resultados: Se incluyeron 11 pacientes con edad promedio de 6.8 años. El diagnóstico se realizó mediante somnoendoscopia. El tipo más frecuente de laringomalacia fue tipo III en 7 pacientes (63.6%), seguido de laringomalacia tipo II en 4 casos (36.3%). 6 de los pacientes (54.5%) presentaban un trastorno genético y/o neurológico asociado. La mayoría de los pacientes mejoraron su sintomatología durante el sueño, aunque 2 no presentaron un resultado favorable tras el procedimiento quirúrgico. Conclusiones: Los resultados de este estudio sugieren una relación entre laringomalacia y SAHOS en la edad pediátrica.

Introduction: Obstructive sleep apnea syndrome is a frequent disease in our region and due to its association with other diseases its importance is high. Larynx´s collapse is a frequent cause of non-improvement (persistence of residual apnea-hypopnea index) after treatment of other obstructive areas inside the airway. Objective: To perform a sociodemographic and clinical description of a series of patients with laryngomalacia and obstructive sleep apnea syndrome. Design: Case series. Materials and methods: We present a report of patients managed at the Hospital Militar Central and University Hospital "Clínica San Rafael" of Bogotá, with obstructive sleep apnea and laryngomalacia syndrome who underwent supraglotoplasty between the years 2015 - 2017. Results: Eleven patients with an average age of 6.8 years were included. The diagnosis was made by somnoendoscopy. The most frequent type of laryngomalacia was type III in 7 patients (63.6%), followed by type II in 4 cases (36.3%). 6 of the patients (54.5%) presented an associated genetic and/or neurological disorder. Most of the patients improved their symptoms during sleep, although some did not show a favorable result after the surgical procedure. Conclusions: The study results suggest a relationship between laryngomalacia and OSAS in children.

Clinical analysis of neonatal upper airway abnormalities / 中国新生儿科杂志

Objective To study early diagnostic methods,treatment and prognosis of neonatal upper airway abnormalities.Method From Jan.2013 to Dec.2016,clinical data of neonates with upper airway abnormalities in neonatal department of our hospital was reviewed,including diagnostic methods,clinical manifestations,examination results,treat-ment and prognosis.Result Fifty-five cases of neonatal upper airway abnormalities were collected,including 34 males and 21 females,51 term infants and 4 premature infants.The most common diagnosis was congenital laryngomalacia (31 cases,14 of them had other upper airway abnormalities),followed by congenital cyst,vocal cord paralysis,laryngeal granuloma,Pierre Robin syndrome,etc.Most cases had presenting symptoms immediately or within days after birth,including dyspnea,cyanosis,laryngeal stridor,feeding difficulties,hoarseness and weak cry.Pneumonia occurred in 49 cases and respiratory failure in 16 cases.Thirty one cases received CT or MRI,abnormalities were found in 17 cases (54.8％).Thirty four cases received fiberoptic bronchoscopy,abnormalities were found in 33 cases (97.0％).The duration of hospital stay were 14 (7 ～20) days.Forty six cases were cured (20 cases received surgical treatment,26 cases conservative treatment),7 cases died (1 case died of chaotic atrial tachycardia and heart failure at 69-day after birth,and 6 cases died after discontinue of treatment),2 cases were lost on follow-up after discharge.Conclusion Newborn infants with upper airway abnormalities develop symptoms early,and some severe cases have respiratory failure.Imaging and fiberoptic bronchoscopy are helpful for diagnosis.Early surgical treatment can relieve airway obstruction and improve prognosis for congenital cyst,laryngeal granuloma,nasopharyngeal tumor and other space occupying lesions,and also severe upper airway obstruction caused by severe laryngomalacia,vocal cord paralysis,choanal atresia.

Long term outcomes of infants with moderate to severe laryngomalacia / 中国小儿急救医学

Objective To determine the long term outcomes of laryngomalacia infants with anomalies and to determine the clinical practice guideline for these infants.Methods The charts of infants with moderate to severe laryngomalacia,who were admitted to our hospital between January 2013 and December 2015,were retrospectively reviewed.These infants were divided into two groups,anomaly(A) group(n=37) and non-anomaly (NA) group(n=19).Results Fifty-six cases were enrolled.Infants in A group were older at symptom relief than those in NA group[(10.00±3.56) months vs.(7.89±3.03) months,P＜0.05],and the weight percentiles of infants in A group were lower at 3,6 and 12 months than those in NA group(P＜0.05).There was no statistically significant difference between the two groups on the weights percentiles in infants at 24 months after diagnosis.Five of 37 cases in A group and 3 of 19 cases in NA group had supraglottoplasty.One infant in A group had tracheotomy.Conclusion Both breathing difficulty and development retardations of infants with moderate or severe laryngomalacia could gradually improved with age.There is not enough evidence to support the aggressive supraglottoplasty for infants with anomalies and laryngomalacia.

Classification and Management in Patients with Laryngomalacia

Laryngomalacia is the most common congenital anomaly that causes inspiratory stridor and airway obstruction in the newborn. Symptoms begin to appear after weeks of age, become worse at 4-8 months, improve between 8-12 months, and usually heal naturally at 12-18 months. Despite these common natural processes, the symptoms of the disease can be very diverse and, in severe cases, require surgical treatment. The diagnosis can be made by suspicion of clinical symptoms and direct observation of the larynx with the spontaneous breathing of the child. Typical laryngeal features include omega-shaped epiglottis, retroflexed epiglottis, short aryepiglottic fold, poor visualization of the vocal folds, and edema of the posterior glottis, including inspiratory supra-arytenoid tissue prolapse. In this review, we discuss the classification and treatment based on symptoms and laryngoscopic findings in patients with laryngomalacia.

Supraglotoplastía láser en laringomalacia severa / Laser supraglottoplasty for severe laryngomalacia

Introducción: La laringomalacia es la causa más frecuente de estridor en lactantes, representando el 60%-70% de los defectos congénitos laríngeos. Entre 10%-20% de estos pacientes puede requerir tratamiento quirúrgico. Objetivo: Revisar las manifestaciones clínicas y los resultados de las supragloto-plastías en laringomalacia severa en nuestro hospital durante 2015. Material y método: Estudio descriptivo retrospectivo mediante revisión de fichas clínicas de pacientes sometidos a supraglotoplastía en el Hospital Guillermo Grant Benavente de Concepción en 2015. Resultados: Se intervinieron 11 pacientes siendo el promedio de edad, al momento de la cirugía, de 7,3 meses. Todos los pacientes tenían dificultad para alimentarse y el 45% además cianosis con la alimentación y el llanto, desaturaciones y pausas respiratorias. Cuatro casos portaban anomalías congénitas asociadas y el 73% presentó lesiones concomitantes de vía aérea, principalmente estenosis subglótica (64%). Los tipos morfológicos observados de laringomalacia fueron los tipos I y II con 27% y 73%, respectivamente. La tasa de éxito quirúrgico fue de 91%, sin necesidad de revisiones y no se presentaron complicaciones relacionadas al procedimiento. Conclusiones: La supraglotoplastía con láser es una técnica segura y efectiva para el tratamiento de laringomalacia severa. Los pacientes con laringomalacia severa debiesen ser sometidos a una revisión completa de vía aérea para evaluar otras comorbilidades.

Introduction: Laryngomalacia is the most common cause of stridor in infants, accounting for 60%-70% of laryngeal congenital defects. Between 10% to 20% of these patients may require surgical treatment. Aim: To review the clinical manifestations and outcomes of supraglottoplasties in severe laryngomalacia at our hospital during 2015. Material and method: Retrospective medical record review of children that underwent CO2 laser supraglottoplasty at Hospital Guillermo Grant Benavente in Concepcion during 2015. Results: Eleven patients were included in this study, the average age at the time of surgery was 7.3 months. All the patients had stridor associated with feeding difficulty and 45% of them also had cyanosis with feeding and crying, desaturations and respiratory pauses. Four cases had associated congenital anomalies and 73% of the patients had airway comorbidity, mostly subglottic stenosis (64%). All of ourpatients had types I and II laryngomalacia with 27% and 73%, respectively. The success rate of surgery was 91%, no patients required a revision supraglottoplasty and there were no complications related to the procedure. Conclusions: CO2 laser supraglottoplasty proved to be a safe and effective treatment for severe laryngomalacia. Patients with severe laryngomalacia should undergo a full airway revision under general anesthesia to assess airway comorbidity.

Clinical characteristics of severe infant laryngomalacia diagnosed by flexible bronchoscopy and the curative effect of laser therapy / 中华实用儿科临床杂志

Objective To explore the clinical characteristics of severe infant laryngomalacia diagnosed by flexible bronchoscopy,and to investigate the effectiveness and safety of treatment on it.Methods Data of 29 severe laryngomalacia patients from Gansu Provincial Maternity and Child-Care Hospital diagnosed by flexible bronchoscopy were analyzed from March 2013 to July 2015,retrospectively.Twelve cases of them received laser therapy under balanced intravenous anesthesia.Preoperative and postoperative pulse oxygen saturation(SpO2),pulmonary function,and dyspnea index were analyzed statistically.Results After supraglottoplasty with laser,the findings were as follows:SpO2(94.26 ± 1.30) ％,tidal volume (6.11 ± 0.77) mL/kg,time to peak tidal expiratory flow/expiratory time 27.42 ±3.51,volume at time of peak expiratory flow/expiratory volume 30.95 ± 5.46,and dyspnea index 1.95 ± 1.05;while preoperative findings were SpO2 (82.45 ± 1.35)％,tidal volume(5.30 ± 1.03) mL/kg,time to peak tidal expiratory flow/expiratory time 27.42 ± 3.51,volume at time of peak expiratory flow/expiratory volume 21.93 ± 7.23,and dyspnea index 2.75 ± 0.84,respectively,and there were significant differences between the preoperative and postoperative therapy (all P ＜ 0.05).Complications were not observed over the next 6 months after operations.Conclusions Severe infant laryngomalacia has influence on living quality of patients,which can be diagnosed by flexible bronchoscopy.Laser therapy is a safe effective cure for it.

Aetiological profile of paediatric stridor in a Malaysian tertiary hospital

Background: Conditions causing stridor in paediatric patients can range from minor illnesses to life-threatening disorders. Proper evaluation and correct diagnosis are essential for timely intervention. The objective of this study was to determine the aetiological profiles and the management of paediatric patients with stridor referred to the Otorhinolaryngology Department of Hospital Serdang. Methods: Medical records of all paediatric patients presenting with symptom of stridor from January 2010 to February 2015 were reviewed retrospectively. The patients’ demographic data, clinical notes, laryngoscope findings, diagnosis and management were retrieved and analysed. Results: Out of the total 137 patients referred for noisy breathing, 121 patients had stridor and were included in this study. There were 73 males and 48 females—most were of Malay ethnicity (77.7%). The age of presentation ranged from newborn to 10 years, with a mean of 4.9 months. Eighteen patients (14.9%) had associated congenital pathologies. The majority were congenital causes (90.9%), in which laryngomalacia was the commonest (78.5%), followed by subglottic stenosis (5.0%), vallecular cyst (2.5%) and congenital vocal fold paralysis (2.5%). Twelve patients (9.9%) had synchronous airway lesion. The majority of the patients were managed conservatively. Thirty-one patients (25.6%) required surgical intervention, of which only one needed tracheostomy. Conclusion: Laryngomalacia was the commonest cause of stridor among paediatric patients. A synchronous airway lesion should be considered if the child has persistent or severe symptoms. The majority of the patients were managed conservatively.

A Case of Aryepiglottoplasty under Conventional Ventilation in Congenital Laryngomalacia Patient / 대한이비인후과학회지

Laryngomalacia is reported as the most common cause of congenital laryngeal stridor. Despite its benign and self-limited aspects, 10% of all cases require intervention. However, endolaryngeal surgery in neonates makes great demands on the anesthesiologist and the surgeon because of the narrowness of the airways. This case report will present a surgical management of severe laryngomalacia in a newborn using the combination carbon dioxide laser and cold instrument to surgically divide the aryepiglottic fold under conventional ventilation.

Estridores laríngeos supraglóticos / Supraglottic laryngeal stridors / Estridores laríngeos supraglóticos

Toda obstrucción de la vía aérea se expresa por un estridor que será diferente según la localización de la obstrucción. El estridor es un ruido ocasionado por el pasaje de aire en forma turbulenta a través de una vía aérea con calibre disminuido. Cuando la obstrucción se ubica por encima de las cuerdas vocales el estridor será inspiratorio. Describimos diferentes patologías de la laringe supraglótica, congénitas y adquiridas, que presentan estridor en algún momento de su evolución.

An obstructed airway causes stridor. Stridor willbe different depending on the location of the obstruction. Stridor is a noise caused by the passage ofturbulent air through a diminished airway caliber. If the obstruction occurs above the vocal cords, itwill be inspiratory. We describe different pathologies of the supraglotticlarynx, both congenital and acquired, producingstridor at some moment of their evolution.

Uma via aérea obstruída provoca estridor. Estridor será diferente dependendo da localização da obstrução. Estridor é um ruído causado pela passagemdo ar turbulento através de uma diminuição do calibre das vias aéreas. Nós descrevemos diferentes patologias da laringe supraglótica, tanto congênitas e adquiridas, que apresentam stridor em algum momento de sua evolução.

Congenital laryngeal anomalies / Anomalias congênitas da laringe

Introduction: It is essential for clinicians to understand issues relevant to the airway management of infants and to be cognizant of the fact that infants with congenital laryngeal anomalies are at particular risk for an unstable airway. Objectives: To familiarize clinicians with issues relevant to the airway management of infants and to present a succinct description of the diagnosis and management of an array of congenital laryngeal anomalies. Methods: Revision article, in which the main aspects concerning airway management of infants will be analyzed. Conclusions: It is critical for clinicians to understand issues relevant to the airway management of infants. .

Introdução: As anomalias congênitas da laringe estão em risco de uma via aérea instável, sendo essencial que o clínico tenha uma boa compreensão dos problemas relevantes para o manuseio das vias aéreas de bebês. Objetivos: Familiarizar os clínicos com os problemas relevantes para o manuseio das vias aéreas de bebês e apresentar uma descrição sucinta do diagnóstico e tratamento de uma série de anomalias congênitas da laringe. Método: Artigo de revisão, no qual serão tratados os principais aspectos relacionados ao manuseio das vias aéreas de bebês. Conclusões: É essencial que o clínico tenha um bom conhecimento dos problemas relevantes ao manuseio das vias aéreas de bebês. .

Tratamento cirurgico da laringomalacia grave: estudo retrospectivo de 11 casos / Surgical treatment of severe laryngomalacia: a retrospective study of 11 case

A laringomalácia é a anomalia congênita da laringe mais frequente, sendo responsável por cerca de 60% a 75% dos casos de estridor congênito. Apesar de seu curso benigno e autolimitado, 10% dos casos necessitam de intervenção. Atualmente, as supraglotoplastias são consideradas o tratamento padrão da laringomalácia grave. OBJETIVO: Descrever a experiência adquirida pelos autores no tratamento cirúrgico dos pacientes com laringomalácia grave. Metodologia: Estudo retrospectivo. MÉTODO: Os prontuários de 11 casos consecutivos de laringomalácia grave, submetidos ao tratamento cirúrgico entre 2003 e 2012, foram analisados quanto à idade, gênero, sintomas, doenças associadas, técnica cirúrgica adotada, tempo de extubação, complicações cirúrgicas, tempo de internação e evolução clínica. RESULTADOS: Dos 11 casos de laringomalácia grave, seis pacientes (54,5%) foram operados com o uso do laser de CO2 e em cinco pacientes (45,5%) foram realizadas a técnica a frio. Apenas um paciente (9,1%) necessitou reabordagem cirúrgica. Não foram observados casos de complicações cirúrgicas. Todos os pacientes apresentaram melhora clínica importante. CONCLUSÃO: A supraglotoplastia mostrou-se um procedimento eficaz e seguro no tratamento da laringomalácia grave. .

Laryngomalacia is the most frequent congenital abnormality of the larynx, accounting for approximately 60-75% of congenital stridor cases. Despite its benign and self-limited aspects, 10% of cases require intervention. Currently, supraglottoplasty is considered the standard treatment of severe laryngomalacia. OBJECTIVE: To describe the experience of the authors in the surgical treatment of patients with severe laryngomalacia. Methodology: A retrospective study. METHOD: The medical records of 11 consecutive cases of severe laryngomalacia who underwent surgical treatment between 2003 and 2012 were analyzed for age, gender, symptoms, associated diseases, surgical technique employed, extubation time, surgical complications, length of hospital stay and clinical outcome. RESULTS: Of the 11 cases of severe laryngomalacia, six patients (54.5%) were operated with the use of CO2 laser and five patients (45.5%) were submitted to the cold technique. Only 1 patient (9.1%) required surgical reintervention. There were no cases of surgical complications. All patients had clinical improvement. CONCLUSION: Supraglottoplasty proved to be effective and safe in the treatment of severe laryngomalacia. .

Supraglotoplastía asistida con microdebridador en pacientes con síndrome de Pierre Robin y laringomalacia severa / Assisted endoscopic microdebrider supraglottoplasty in patients with Pierre Robin syndrome and severe laryngomalacia

Se presenta el caso de una paciente recién nacida de término portadora de un síndrome de Pierre Robin asociada a laringomalacia severa que requirió resolución quirúrgica para estabilización de su vía aérea superior Se presenta la experiencia clínica en el uso de microdebridador para realización de supraglotoplastía como una novedosa alternativa en el tratamiento quirúrgico de este tipo de pacientes y se realiza revisión de la literatura respecto de esta técnica.

Pierre Robin syndrome is a triad formed by micrognathia, and cleft palate glossoptosis. His association with laryngomalacia is not set however determining the coexistence of these two diseases and their severity is of utmost importance as they condition the prognosis of a patient with Pierre Robin syndrome. Currently one of the surgical techniques used in patients with severe laryngomalacia, is assisted endoscopic microdebrider supraglottoplasty. In the ENT unit of the Hospital Luis Calvo Mackenna, this procedure is being implemented in order to give our patients a safe and effective treatment option for their pathology.