Pediatric Epiglottopexy: A Scoping Review of Indications, Techniques, Outcomes, and Complications

To map and synthesize the evidence on epiglottopexy in pediatric patients with laryngomalacia, epiglottic prolapse, and obstructive sleep apnea (OSA) with attention to indications, techniques, outcomes, complications, and evidence gaps.

PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar were searched from January 1980 to May 2026 for English- and French-language studies, supplemented by hand-searching of reference lists.

This scoping review followed PRISMA-ScR guidelines. The review protocol was registered on OSF prior to data extraction. Eligible studies were original reports of pediatric patients (< 18 years) who underwent epiglottopexy for any indication. Two reviewers independently screened records and extracted data; findings were synthesized descriptively.

Twenty-four studies (371 patients) published between 1987 and 2026 met inclusion criteria, comprising case reports, case series, and retrospective cohorts from 10 countries. Surgical approaches included endoscopic CO₂ laser or cautery-assisted glossoepiglottopexy, transoral suture-based epiglottopexy, transcervical external fixation, and robot-assisted epiglottopexy. Indications spanned classic Type III laryngomalacia, epiglottic prolapse complicating tracheostomy-dependent or syndromic airway disease, and increasingly, drug-induced sleep endoscopy (DISE)-confirmed epiglottic obstruction in children with refractory OSA. Respiratory improvement was consistently reported, swallowing function was largely preserved or improved, and complication and recurrence rates were low, with single-procedure success in most cases.

Epiglottopexy is reported to be safe and effective for pediatric epiglottic prolapse across diverse clinical contexts and techniques. DISE has expanded its indications to sleep-state-dependent epiglottic obstruction. Evidence remains limited by small, retrospective series; prospective studies with standardized DISE protocols, outcome measures, and longer follow-up are needed.

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