[Severe congenital laryngeal stridor. Endoscopic surgical treatment]

Congenital laryngeal stridor or laryngomalacia is a congenital disease causing an usually shrill and solitary inspiratory noise, sometimes associated with disorders of deglutition and dyspnea when crying. Most often, the symptoms spontaneously disappear before the age of two. However, some cases are very severe, with permanent dyspnea, leading to tracheal intubation or tracheotomy. To avoid the risks of prolonged tracheotomy in infants, a new surgical technique has recently been described, beside epiglottectomy and hyomandibulopexy, now abandoned. This is simple endoscopic section and resection of the ary-epiglottic folds. Preliminary results in 15 patients seem to show the superiority of this so-called epiglottoplasty technique. Except in one case with supraglottic oedema attributed to a major gastro-esophageal reflux, all patients recovered from their dyspnea with this procedure. Extubation usually was rapidly feasible and the post-operative period was uneventful. The patients are kept in hospital for 2 to 5 days, and an antibiotic and anti-reflux treatment is recommended. This procedure is advocated as a treatment of choice of "laryngomalacia" with severe dyspnea.