Surgical treatment of severe laryngomalacia:

a huhu
retrospective study of 11 case
galau ni, tapi w tetep sore aja de, pagi nya mau pergi dulu
karnaa, maafin ya jaa

José Antonio Pinto, Henrique Wambier, Elcio Izumi Mizoguchi, Leonardo Marques

Gomes, Rodrigo Kohler, Renata Coutinho Ribeiro

Presented by Fateha Putri Hakim, MD

Jakarta, November 27th 2020
BACKGROUND  Affecting 60-75% of congenital stridor case
 Typically begin at age 2 weeks, with
incidence peak around 6 months
LARYNGOMALACIA  10% cases require intervention ~ severe
laryngomalacia

Aryepiglottoplasty
Pathogenesis is uknown, Intervention Arytenoidoplasty
- Tracheotomy
 Exacerbated in the supine position - Hyomandibulopexy Epiglottoplasty
during feeding, agitation and crying - Supraglottoplasties Epiglottoplexy
 A collapse of supraglottic tissues Epiglottectony
during inspirations  producing
inspiratory stridor

AIMS: Describe and evaluatevcases in the surgical treatment

of patients with severe laryngomalacia
 METHODS
• Longitudinal historical Cohort Study
• Pediatric ICU – Tertiary Hospital

January 2003 April 2012

Inclusion Exclusion
Patient with severe laryngomalacia who Patient with severe laryngomalacia who not take
underwent surgical treatment surgical treatment

Age Gender
Hospital Stay

Variables Evaluated Symptomps Assosiated disorders

Clinical Outcome
Surgery Extubation time
 RESULTS
Cases Age Gender Symptomps Associated diseases Surgical Treatment Extubation Hospital Clinical Outcome
Stay
1 3 M Stridor, dypsnea, Hypoxic Bilateral 48H 34 days Progressive symptom
Months cyanosis encephalopathy, aryepiglottoplasty improvement
bronchopulmonary & CO2 laser
dysplasia, renal failure Vaporization of the
lingual face of the
epiglottis
2 2 M Stridor, dypsnea, None Bilateral Immediate post 1 day Progressive symptom
Months cyanosis aryepiglottoplasty op improvement
& CO2 laser
3 3 F Stridor, furcula Hypoxic Bilateral 48H 7 days Progressive symptom
Months retraction, dyspnea, encephalopathy, aryepiglottoplasty improvement
cyanosis ischemic hypoxia & CO2 laser
4 1 M Cyanosis, apnea, insuff. GERD -Cold bilateral 48H 35 days Progressive symptom
Months weight gain aryepiglottoplasty + improvement
aryepiglottoplasty and
removal of the
redundant arytenoid
mucosa with the CO2
laser

5 2 M Dyspnea, Bronchospasm None -Cold bilateral Immediate post 100 Need for
Months aryepiglottoplasty op. Reintubation days reintervention and
-Bilateral after 3 days for Progressive symptom
aryepiglottoplasty resp. distress improvement
& CO2 laser
6 2 M Stridor, furcula & Down Syndrome, Cold bilateral Immediate post 20 days Progressive symptom
Months intercostal Retraction GERD aryepiglottoplasty op improvement
7 4 M Dysphagia, Stridor, Interatrial Cold bilateral 48H 31 days Progressive symptom
Months furcula intercostal communication aryepiglottoplasty improvement
 Discussion (1)
Laryngomalacia
 Predominance among male patients.
 The inspiratory stridor is the most
important & frequent symptom
Indication surgical treatment:
 Development delays
 Feeding issues
 Severe gastroesophageal reflux
 Airway obstruction symptomps

Unilateral supraglottoplasty [Kelly Gray]: Bilateral aryepiglottoplasty [Loke et al]:

-successful surgery in 94% of cases w/o
major complications (involving 18 patiens)
-In 16.67% of cases required a bilateral
aryepiglottic fold approach
-Complete resolution of stridor in 68.7% of
cases (involving 33 patiens)
-Partial resolution in seven (21.8%)
-Reoperation surgery in two patients
-One patient with multiple malformations
underwent tracheostomy

 Bilateral aryepiglottoplasty as the procedure of choice at author institution

 The epi-glottoplasty and arytenoidoplasty are kept as a complementary
method to aryepiglottoplasty, to improve the supraglottic obstruction.
 Complications of supraglottoplasty:
Discussion (2) • Bleeding • Dysphagia
• Edema • Supraglottic
• Infection stenosis
Excessive removal of laryngeal tissues • Aspiration • Synechia
rather than bilateral aryepiglotoplasty • Respiratory
failure and
death
The use of CO2 laser:
The different compare to previous study: -decrease risk of intraoperative bleeding
- Less patient presents transient aspiration and postoperative edema in cases of
- Patients in ICU for a min. 24 hours greater mucosal resection, as in
- Diagnosis based on clinical and nasal- epiglottoplasty and arytenoidoplasty
laryngoscopy findings --- no cases of synchronous
lesions happen in patients

 The diagnosis of laryngomalacia is being restricted to the tertiary level of care

 The success rate of supraglottoplasty is about 38-100%
 The clinical improvement of all patients submitted to surgical treatment reach 100% of
cases
CONCLUSION
• Supraglottoplasty  an effective procedure in the treatment of respiratory
obstruction, which enlarging the laryngeal lumen.
 Its has high resolution, and less surgical complication.
 a safe procedure in the treatment of children with severe
laryngomalacia