Laryngomalacia. A review and the surgical management for severe cases

Laryngomalacia with its characteristic inspiratory collapse of lax supraglottic tissues into the laryngeal inlet may on occasion cause obstruction of such severity as to require airway intervention. The anatomy of the condition and the physiological explanation for its clinical presentation are examined and the pathological changes that precipitate a life-threatening situation discussed. Surgical correction of the abnormal tissue represents an acceptable alternative to tracheostomy in this situation. Simply 'trimming' the lax tissue over the arytenoid mounds may suffice in some cases but complications can occur and stabilisation of the epiglottis should be attempted as well. A series of 11 infants on whom such surgery was performed is presented with discussion of the surgical procedures performed and the complications experienced. The current uniformly successful surgical management of severe laryngomalacia by 'supraglottic trimming' combined with 'anterior epiglottopexy' is advocated for correction of severe laryngomalacia.