The current status of corrective surgery for laryngomalacia

When the airway obstruction related to laryngomalacia becomes significant, surgical correction of the underlying laryngeal deformity is indicated. The three elements of the supraglottic soft tissue that prolapses, namely, the corniculate mounds on the arytenoid cartilages, the shortened ary-epiglottic folds, and the omega shaped epiglottis, can all be appropriately "trimmed" using either conventional instruments or the surgical laser. Relief of symptoms is dramatic and, provided surgery is performed precisely and not during episodes of infection, complications should not occur. The aid of specialized, skillful anesthesia is required for this type of surgery. We present a series of 40 children with significant obstruction: 30% had neuromuscular disorders, 68% had an infantile epiglottis, seven required airway support prior to surgery, all had laser "supraglottic trimming," and 13 required airway support after surgery. Relief of stridor and airway obstruction was generally rapid. There was only one complication: croup developing 4 days after surgery.