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Surgical treatment of severe laryngomalacia: Six month follow up
Author(s) -
Baljosevic Ivan,
Minic Predrag,
Trajkovic Goran,
MarkovicSovtic Gordana,
Radojicic Bojana,
Sovtic Aleksandar
Publication year - 2015
Publication title -
pediatrics international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.49
H-Index - 63
eISSN - 1442-200X
pISSN - 1328-8067
DOI - 10.1111/ped.12706
Subject(s) - medicine , laryngomalacia , dysphagia , body mass index , surgery , stridor , reflux , anesthesia , airway , disease
Background Laryngomalacia (LM) is the most common congenital anomaly of larynx that causes stridor in children. We evaluated the efficacy of epiglottic suture and laser epiglottopexy for treatment of infants with severe LM. Methods Surgical intervention was performed in 19 patients with severe LM, after the diagnosis was established using flexible laryngotracheobronchoscopy. Five patients had isolated type 1 LM, and 14 patients had a combination of type 1 and 3 LM. Indication for surgical treatment was the presence of LM with at least one of the following: malnutrition (body mass index [BMI] Z score < –2 SD), dysphagia or symptoms of gastroesophageal reflux and mean oxygen saturation (SaO 2 ) <92% with oxygen desaturation index (ODI) > 3. Results Epiglottic suture was performed in 11 patients, and laser epiglottopexy in eight, at mean age 3.95 ± 2.4 months. Rate of operation was 2.2‐fold greater for more severe anomaly (combination of type 1 and 3 LM) than for isolated type 1. At 6 month follow up symptoms had gradually improved, as well as nutritional status, with increase of mean BMI Z score from –3.7 to –0.9 ( P < 0.01). Mean preoperative SaO 2 was 89.4 ± 4.3% with mean ODI of 5.8. At 6 month follow up, mean SaO 2 was 96.7 ± 1.1%, and mean ODI was 1.2 ( P < 0.01). Conclusions Epiglottic suture and laser epiglottopexy are efficient surgical techniques that lead to significant improvement of symptoms, oxygenation and nutritional status in patients with LM.