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Epiglottopexy in Infants Younger Than 6 Months Old: A Case Series
Inbal Hazkani1,2, Eli Stein2, Saied Ghadersohi1,2
1Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Insights
This study shows that combining epiglottopexy with supraglottoplasty improves breathing in infants with severe laryngomalacia. However, some infants may experience new swallowing difficulties, especially those with existing health issues.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Surgery
- Neonatal Care
Background:
- Severe laryngomalacia can cause apnea, hypoxia, and feeding issues, often needing supraglottoplasty surgery.
- Infants requiring early surgery or with comorbidities present unique challenges.
- Posterior epiglottic displacement in congenital stridor is often treated with epiglottopexy.
Purpose of the Study:
- To evaluate the outcomes of combined epiglottopexy and supraglottoplasty in infants under six months with severe laryngomalacia.
- To assess the effectiveness and potential complications of this combined surgical approach.
Main Methods:
- Retrospective chart review of infants under six months old.
- Study period: January 2018 to July 2021 at a tertiary care children's hospital.
- Inclusion criteria: Severe laryngomalacia treated with supraglottoplasty and epiglottopexy.
Main Results:
- 13 infants (1.3 weeks-5.2 months) underwent the combined procedure for laryngomalacia and epiglottic retroflection.
- All patients showed subjective and objective improvement in respiratory symptoms.
- Postoperative aspiration occurred in 10 patients; 2 required tracheostomy due to comorbidities, and 1 needed revision surgery.
Conclusions:
- Combined epiglottopexy and supraglottoplasty can significantly improve respiratory symptoms in young infants with severe laryngomalacia, even those with comorbidities.
- Postoperative dysphagia can be a complication, particularly in infants with underlying medical conditions.
Background:
Severe laryngomalacia, characterized by apnea, hypoxia, and feeding difficulties, is an uncommon diagnosis that often requires surgical intervention with supraglottoplasty. Children who require surgery at a young age and those with additional comorbidities pose a special challenge and may require further surgical interventions. Posterior displacement of the epiglottis has been noted in some infants with congenital stridor and is commonly treated with epiglottopexy. The goal of our study is to review the outcomes of epiglottopexy combined with supraglottoplasty in our cohort of infants younger than 6 months old with severe laryngomalacia.
Methods:
A retrospective chart review of infants younger than 6 months old who underwent epiglottopexy combined with supraglottoplasty for severe laryngomalacia from January 2018 to July 2021 at a tertiary care children's hospital.
Results:
13 patients (age 1.3 week-5.2 months) underwent supraglottoplasty and epiglottopexy for severe laryngomalacia and epiglottis retroflection. The patients were admitted to the intensive care unit and remained intubated for at least one night. All patients demonstrated subjective and objective improvement in upper airway respiratory signs and symptoms. Ten patients demonstrated aspiration immediately postoperatively, despite 4 of them having no concern for aspiration at preoperative evaluation. On follow-up, 1 patient required revision supraglottoplasty and epiglottopexy for persistent laryngomalacia, and 2 patients required tracheostomy tube placement due to cardiopulmonary comorbidities.
Conclusion:
Infants younger than 6 months old with medical comorbidities undergoing epiglottopexy with supraglottoplasty may demonstrate significant improvement in respiratory symptoms. Worsening dysphagia may complicate the postoperative period, particularly among children with medical comorbidities.
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