Supraglottoplasty for laryngomalacia: who will benefit?

Laryngomalacia is the most common cause of neonatal and infantile stridor. The aim of this study was to assess the outcome of surgical intervention in children with laryngomalacia.

Between January 1998 and December 2008, 15 children with laryngomalacia underwent surgical intervention at the Universiti Kebangsaan Malaysia Medical Centre, from which only eight case notes were available. These were retrospectively reviewed for demographic data, symptoms, comorbidities, operative technique, postoperative recovery, complications, length of hospital stay including intensive care unit (ICU) care, and resolution of symptoms.

Patients consisted of seven males and one female. One patient underwent three procedures, resulting in a total of 10 procedures for this study. The mean age was 15.6 months (range: 2-39 months). The most common indication for surgery was severe stridor resulting in failure to thrive. Intra-operatively, all patients were found to have short aryepiglottic folds, and four also had redundant arytenoid mucosa. Supraglottoplasty was performed in 10 patients: three by cold instruments and seven by laser. Successful extubation was achieved in the operating theatre in eight patients while the other two were extubated in the ICU on the same day. Postoperative ICU nursing was required in six patients: three for up to 3 days, and three for longer periods because of medical problems. Resolution of stridor was complete in four patients, partial in one, and no difference in five. Two patients defaulted follow-up. There were no postoperative complications from the procedures. The average length of follow-up was 15 weeks (range: 12 days to 7 years).

Supraglottoplasty remains an effective method to treat severe laryngomalacia. Patients who will benefit most are those with severe laryngomalacia that is uncomplicated by neurological conditions or multiple medical problems. In our institution, early extubation is the norm, and a significant number of patients can be nursed in the normal wards and be discharged within 48 hours of the procedure.