LARYNGOMALACIA,

TRACHEOMALACIA and
BRONCHOMALACIA
Dr. Florecilla D. Nelmida-Ecube
Senior Lecturer
LARYNGOMALACIA
 A disorder that affects the larynx ( voice box ) of infants
 Most often presents with noisy breathing or stridor as early as 2 weeks of age
 Infants with laryngomalacia will have a stridor and may also have difficulty in breathing, feeding
and gaining weight, failure to thrive and respiratory distress
 This will lead to poor quality of life and anxiety to parents
 The larynx of a child with laryngomalacia will present as one or all of the following
1. Excess tissue overlying the arytenoid cartilages ( cartilages above the voice box ) with
evidence of arytenoid cartilages falling into the airway ( arytenoid prolapse )
2. Short aryepiglottic folds ( AE folds )
3. Omega-shaped epiglottis and prolapse of the epiglottis into the airway
 This prolapse of airway structures during inspiration is what leads to airway distress in children
with laryngomalacia
 The noisy breathing in these children is caused by increased resistance of air flowing through the
larynx due to the tissue blocking the airway
LARYNGOMALACIA

 CAUSES
--The exact cause is not known
-- The underlying dysfunction is related to redundant mucosa, poor support of the laryngeal
cartilages and poor neurological tone
-- Laryngomalacia is due to a delay in neurological function and tone of the laryngeal structures
above the vocal cords ( most widely accepted theory )
LARYNGOMALACIA
 TREATMENT
1. Positioning and treatment for gastric reflux ( first line treatment )
-- parents will be instructed to position their child on their stomach when the child
has difficulty breathing
-- never leave the baby alone when the baby is on his stomach ( prone )
2. Eating is typically easier for babies for babies with laryngomalacia if they are sitting up
3. Mostly prescribed with medication to decrease acid reflux
4. If all fail, surgery is recommended
LARYNGOMALACIA
 SURGERY
-- Most of the time, laryngomalacia will resolve at 12 to 18 months of age without surgical
intervention
---Surgical intervention is warranted if the baby has severe laryngomalacia with recurrent
apneic events, difficulty in feeding, failure to thrive and recurrent cyanosis and
respiratory distress
--- Supraglottoplasty – a surgical technique in which the structures of the larynx are altered
in order to prevent collapse of the airway and improve breathing
- while the baby is asleep, the surgeon will use a laryngoscope to look inside the
mouth and evaluate the larynx, then alter the airway to decrease obstruction
- short aryepiglottic folds are cut in order to lengthen them and provide a more
open airway
- excess arytenoid tissue can be trimmed down for it not to prolapse into the airway
----Epiglottopexy – technique attaches the epiglottis to the base of tongue to prevent the epiglottis to
fall into the airway
TRACHEOMALACIA
 A condition where the tracheal cartilage (windpipe ) rings soften and partially collapse when a child
is breathing
 The collapse occurs during expiration
 Maybe primary or secondary
Primary tracheomalacia – is cause by anterior prolapse of the posterior tracheal wall
Secondary tracheomalacia –rare, caused by external compression, most often caused by a
vascular anomaly where an artery compresses and weakens the tracheal
cartilage leading to collapse ( eg. Aberrant right subclavian artery, pulmonary
artery sling, and vascular rings/slings )
 In most cases, this is managed without surgical intervention
TRACHEOMALACIA
 SYMPTOMS
1. High pitched breathing
2. Rattling or noisy breathing ( stridor )
3. Frequent infections in the airway such as Bronchitis and Pneumonia ( due to inability to
cough and clear the lungs properly )
4. Frequent noisy cough
5. Exercise intolerance
6. prolonged respiratory infections
7. More severe signs – choking during feeding, apnea, cyanosis
TRACHEOMALACIA
 SYMPTOMS
1. High pitched breathing
2. Rattling or noisy breathing ( stridor )
3. Frequent infections in the airway such as Bronchitis and Pneumonia ( due to inability to
cough and clear the lungs properly )
4. Frequent noisy cough
5. Exercise intolerance
6. prolonged respiratory infections
7. More severe signs – choking during feeding, apnea, cyanosis
TRACHEOMALACIA
 MANAGEMENT
---Common misconception that children outgrow tracheomalacia over time ( misconception )
----Infants must be monitored closely by the team and maybe given humidified air, chest
physiotherapy and continuous positive airway pressure ( CPAP ) and pulmonary clearance
regimen supervised by a pulmonologist
----if the child is having cyanosis, choking when eating, stridor, coughing , exercise intolerance
or pneumonia despite maximal medical treatment , Surgery is recommended
--- Treatment depends on the type and locations of the tracheomalacia
1. Aortopexy – trachea opens up by moving up the aorta and then attached to sternum
2. Tracheopexy - suspends the part of tracheal wall from the back of sternum
3. Bronchopexy – it improves air flow
4. Combined procedures
 Although the condition can improve by its own, some children don’t outgrow the more severe
forms
BRONCHOMALACIA

 Very similar to Tracheomalacia, however, the cartilage softening occurs in the bronchi of the
lungs
 When this collapse occurs in the bronchi, it is called Bronchomalacia
 Can also be primary and secondary
AIRWAY MALACIA
 Laryngomalacia is very common, the most common cause of stridor in children and
affects 35-75% of infants presenting with stridor