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2011, Pediatric Research
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Background: Laryngomalacia is the most common cause of congenital stridor. It usually presents by high pitched inspiratory stridor which is often present at birth and is usually noticed by 2 weeks of age. Aim: The aim of this study was to assess clinical presentation, management and prognosis of infants and children suffering from laryngomalacia presented to our department in the period of 5 years. Methods: Retrospective analysis of the medical sheath records of newborns and infants suffering of laryngomalacia were reviewed regarding demographic data, clinical presentation, diagnosis and management. Results: Fifty eight infant and child were included in the study. They were 33 males (57%) and 25 females (43%). Their age at presentation ranged from 2-13 months. Diagnosis was done using laryngoscopy under general anesthesia with spontaneous breathing in 49 patients (85%) and by using flexible nasopharyngolaryngoscopy under topical anesthesia in 9 patients (15%). Conservative treatment was given for all cases in the form of diet modification, lansoprazole and Domperidone. For mild cases, gradual improvement occurred within 1 to 3 months. For severe cases, surgical intervention was planned. Indications for surgical intervention were severe airway obstruction with attacks of cyanosis, feeding difficulties and aspiration, weight loss and failure to thrive. Conclusion: Laryngomalacia is the most common congenital anomaly of the larynx. It usually presents within 2 weeks after birth. Diagnosis depends on visualization of the larynx during respiration. Conservative treatment is the rule. Surgical treatment is only indicated in 10% of cases
American Journal of Otolaryngology, 2000
Congenital malformations of the larynx are relatively rare but may be life-threatening. The most common causes include laryngomalacia, vocal cord paralysis, and subglottic stenosis. The last 20 years has seen major advances in the field of surgical correction of such anomalies also serving to reduce the number of tracheotomies in children and the inherent dangers they pose. Success rates for the most popular surgical procedures have been favorable. These include supraglottoplasty for cases of severe laryngomalacia, in which relief of respiratory symptoms has been shown to occur in excess of 80% of cases. Complication rate is low, although postoperative death has been reported. Failure usually occurs in patients with concomitant airway abnormalities including pharyngomalacia. Vocal cord lateralization for vocal cord paralysis with airway compromise is achieved by means of arytenoidopexy or arytenoidectomy, using the lateral approach. Arytenoidectomy also can be performed using laryngofissure or endoscopic laser excision. Subglottic stenosis is the 3rd most common congenital anomaly. Anterior or multiple cricoid splitting with cartilage graft interpositioning is usually performed. The success rates for these procedures has been shown to be approximately 90%.
JAMA Otolaryngology–Head & Neck Surgery, 2014
IMPORTANCE The classic presentation of laryngomalacia (LM) is stridor, but alternate presentations include snoring and/or sleep-disordered breathing (S-SDB) and swallowing dysfunction (SWD). Several classification schemes have been developed for LM, but to our knowledge, none have been successfully investigated as to the ability to predict parameters of patients with LM or surgical outcomes. OBJECTIVE To compare parameters of patients with different types of LM and determine whether the type has prognostic value for surgical outcomes and to explore if any variable predicts or correlates with the type of LM. DESIGN, SETTING, AND PARTICIPANTS Retrospective case series from a single tertiary pediatric otolaryngology practice. Patients with LM treated with supraglottoplasty (SGP) were eligible. We included patients with confirmed diagnosis of LM who underwent a cold steel SGP and had complete resolution of symptoms or at least 3 months of follow-up, with complete data.
Indian Journal of Otolaryngology and Head & Neck Surgery, 2010
Laryngomalacia is the most common condition causing inspiratory stridor at or shortly after birth accounting for approximately 60% of cases. Inspiratory stridor typically occurs after few days or week and is initially mild, but over a period of 6-9 months it gets more pronounced. Spontaneous improvement usually occurs over a period of 18 months to 2 years. Although majority of cases of laryngomalacia have benign course without any long-term sequel. Typically symptoms are worse during sleep and supine position while the same improves in prone position. There are 12 cases in the present study with the average age of the baby was 4.74 months (142 days). Male to female ratio of 1:1. Those babies with life-threatening apnea, significant cyanotic (blue) spells, failure to thrive with feeding difficulty, significant chest wall and neck retractions with breathing and requires oxygen to breathe were included in the study. One patient presented with tracheostomy tube in place. Two babies were preterm. These preterm babies were initially kept on ventilator before the final diagnosis was made. The findings were different in all the cases. The common findings are cyclical collapse of supraglottic larynx with inspiration, short aryepiglottic folds, indrawing of cuneiform and corniculate cartilages forward over the laryngeal inlet resulting in prolapse during inspiration. The surgical procedures in laryngomalacia babies were combined according to the type of laryngomalacia. The procedures performed were supraglottoplasty (Unilateral/ Bilateral), epiglottoplasty, aryepiglottoplasty, aryepiglottic fold division, epiglottopexy. The procedures were performed by radiofrequency cautery under general anesthesia. The average hospital stay in nine patients was less then 36 h and more then 7 days in remaining three patients. In tracheostomized patient second surgical procedure was done as after the first procedure failed to decannulate the child. The postoperative period was uneventful. The average follow up was 10 months.
Operative Techniques in Otolaryngology-Head and Neck Surgery, 1999
able in part to an attempt to overcome these difficulties and complications. This article reviews the surgical treatment of the most common laryngeal anomalies, namely LM, vocal cord paralysis, and subglottic stenosis, with emphasis on indications and results of different surgical techniques.
International Journal of Pediatric Otorhinolaryngology, 2023
Laryngomalacia is the dynamic collapse of supraglottic structures during inspiration, leading to a variable degree of airway obstruction. Clinical symptoms appear in the first months of life and are usually mild and resolve by the age of 12-18 months. In severe cases, surgical intervention may be considered. The goal of the study was to review the clinical outcome of pediatric patients who underwent supraglottoplasty for laryngomalacia. Material and methods: Clinical and demographic data were retrieved from medical records of children diagnosed with laryngomalacia by laryngo-bronchoscopy between 2013 and 2019. Indications, outcome and long-term follow-up were collected from children undergoing surgery. Results: During the study period, 115 children were diagnosed with laryngomalacia. The median age at diagnosis was 3 months. Synchronous airway lesions were diagnosed in 20% of patients. Ten (8.7%) children underwent surgical treatment because of significant respiratory symptoms and/or failure to thrive. Three of them had comorbidities. All otherwise healthy children had significant respiratory and nutritional improvement after surgery while those with comorbidities had less successful outcomes. Conclusion: We conclude that in severe cases of laryngomalacia, supraglottoplasty has an important role to play in management. In children with comorbidities, the surgical results may be less successful. Therefore, we recommend that the decision to operate should be individualized, ensuring full disclosure to the family regarding the probable benefit along with the limitations of surgery.
Ear, nose, & throat journal, 2006
Laryngomalacia, the most common congenital laryngeal anomaly, is not a single disease entity but rather a variety of entities along a spectrum of underlying pathophysiologies. Based on our study of 10 children who were surgically treated for laryngomalacia in an urban tertiary care center, we have developed a system of classifying laryngomalacia on the basis of its different underlying pathophysiologic processes. Type I laryngomalacia is characterized by a foreshortened or tight aryepiglottic fold. Type 2 disease is defined by the presence of redundant soft tissue in the supraglottis. The type 3 designation applies to cases caused by other etiologies, such as underlying neuromuscular disorders. While the three types are not mutually exclusive, each should be considered as a separate disease entity with a final common clinical presentation. Each type requires a specific approach to surgical repair.
Turk Otolarengoloji Arsivi/Turkish Archives of Otolaryngology, 2016
Objective: The aim of this study is to analyse the clinical symptoms, follow-up and treatment properties of the laryngomalacia patients that we encountered between 2009 and 2014. Methods: Records of 81 laryngomalacia patients who were followed up in our clinic between 2009 and 2014 were retrospectively analysed. Patients' gender, age, time of onset of the symptoms, chief complaints, other co-existing congenital laryngeal anomalies and treatment and follow-up properties were evaluated. Results: Of the 81 patients, 48 were male and 33 were female, and the mean age was 4.9 months. The average period of follow-up was 12.1 months. The chief complaints at the time of admission were stridor (100%) and episodic cyanosis with feeding (27.16%). Symptoms of 75 patients were resolved at an average of 8.2 months with conservative treatment. Three patients underwent supraglottoplasty. Tracheotomy and posterior cordotomy was performed for a patient with co-existing vocal cord paralysis. Additional tracheotomy was necessary for a patient with pulmonary co-morbidities and for another with co-existing subglottic stenosis. Conclusion: Laryngomalacia is the most common cause of stridor in infants. The majority of laryngomalacia patients can be managed conservatively by close follow-up. For patients in whom respiratory and feeding problems persist or growth retardation develops, surgical treatment is performed. Tracheotomy may be necessary for a small group of patients with additional diseases.
Diagnostics
Laryngomalacia (LM) is the most common airway congenital anomaly and the main cause of stridor in infants. Some patients with severe airway symptoms or with feeding difficulties require surgical intervention. Synchronous airway lesions (SALs) may influence the severity and course of the disease. This study aimed to determine the prevalence of various types of LM and SALs and their influence on surgical intervention decisions and feeding difficulties. Moreover, the study focused on the interrelations between SALs and the type of LM or the presence of feeding difficulties. A retrospective analysis of 106 pediatric patients revealed a significant relationship between type 2 LM and the necessity of surgical treatment. We also found a significant effect of LM type 2 on feeding difficulty. Type 1 LM is significantly more characteristic in premature children. Among different comorbidities, SALs are suspected of modification of the course and severity of LM. This study did not find a signif...
JAMA Otolaryngology–Head & Neck Surgery, 2014
IMPORTANCE Laryngomalacia (LM) classically presents with stridor in early infancy but can present atypically with snoring and/or sleep-disordered breathing (S-SDB) or swallowing dysfunction (SwD). The epidemiology of these atypical presentations has not been established in the literature. OBJECTIVE To document the primary modes of presentation for LM in a consecutive series of children and to compare the characteristics of each subgroup. DESIGN, SETTING, AND PARTICIPANTS Retrospective case series in a single tertiary pediatric otolaryngology practice. Outpatient and surgical records were searched for patients diagnosed as having LM from 2002 to 2009. We included all children with endoscopically confirmed LM without prior documentation of the diagnosis (n = 88). INTERVENTIONS Patients were investigated and managed according to the routine practice pattern of the senior author. MAIN OUTCOMES AND MEASURES The primary outcome measure was the proportion of the various primary presentations of LM. Age, sex, type of LM, management, and secondary diagnoses were also collected. Subgroup analysis was performed. RESULTS Of 117 potentially eligible patients identified, 88 children had a confirmed diagnosis of LM and were thus included (1.9:1 male to female sex ratio; mean [SD] age, 14.5 [23.0] months; age range, 0.2-96.0 months). Fifty-six children (64%) presented primarily with awake stridor and variable respiratory distress; 22 (25%) with S-SDB; and 10 (11%) with SWD. The difference in mean (SD) age for each group was statistically significant by analysis of variance: stridor, 3.5 (2.8) months; S-SDB, 46.0 (27.2) months; and SwD, 4.8 (4.6) months (P < .001). By χ 2 analysis, sex distribution was not significantly different between subgroups (P = .29), nor was the proportion of children who underwent supraglottoplasty (P = .07). The difference in proportion of types of LM between the stridor and atypical presentations was statistically significant (χ 2 P < .05), with type 1 LM predominating in children presenting with S-SDB. CONCLUSIONS AND RELEVANCE Because LM may present primarily with S-SDB and SwD in a significant proportion of children, the diagnosis must be considered in patients presenting with these upper airway complaints. The morphologic type of LM may vary by presentation.
Ear, Nose & Throat Journal, 2004
Laryngomalacia is the most common cause of stridor in newborns and infants. Patients usually present with an inspiratory stridor only, although some exhibit other anomalies. To rule out other possible pathologies, bronchoscopy is advisable. However, the authors of some recent studies have advocated the use of fiberoptic laryngoscopy as a more cost-effective and less-invasive alternative. No surgical intervention is required to treat laryngomalacia in most cases. The disease usually resolves spontaneously by the time a patient reaches the age of 24 months. In this article, we describe a case of laryngomalacia that was atypical in that the patient was 10 years old. We also review the literature in an effort to increase awareness of this condition.
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