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Severe laryngomalacia: surgical indications and results in 115 patients
G Roger1, F Denoyelle, J M Triglia
1ENT and Head and Neck Surgery Department, Armand Trousseau Children's Hospital, Paris, France.
Insights
Severe laryngomalacia in children can be effectively treated with endoscopic resection of aryepiglottic folds. This minimally invasive procedure offers a 98% success rate, improving breathing and swallowing with minimal risk.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Surgery
Background:
- Severe laryngomalacia presents significant challenges in pediatric care.
- Gastroesophageal reflux was identified in 68% of affected children, complicating diagnosis.
Purpose of the Study:
- To evaluate the efficacy of endoscopic resection for severe laryngomalacia.
- To assess the long-term outcomes of this surgical intervention.
Main Methods:
- A cohort of 115 children with severe laryngomalacia underwent endoscopic resection.
- Procedures involved aryepiglottic fold resection, with or without CO2 laser.
- Clinical manifestations and pH monitoring were used for diagnosis.
Main Results:
- Endoscopic resection led to rapid improvements in ventilation and swallowing.
- The procedure demonstrated a 98% success rate over a 30-month follow-up.
- Only two patients required tracheotomy, indicating high efficacy.
Conclusions:
- Endoscopic resection is a safe and highly effective treatment for severe laryngomalacia.
- This minimally invasive technique offers excellent outcomes and minimal morbidity.
- It is a recommended surgical option for managing severe pediatric laryngomalacia.
Abstract:
Between 1987 and 1993, 115 children were operated on for severe forms of laryngomalacia in two pediatric ear, nose, and throat (ENT) departments. The criteria used to determine the severity of the illness were selected following short hospitalization periods during which the children received both pediatric and ENT checkups. Based on clinical manifestations and/or the results of pH monitoring gastroesophageal reflux was found to be present in 68% of the children in the study. Detailed analysis and endoscopy were used to differentiate the symptoms that were related to laryngomalacia from those that were caused by other conditions, including mixed-breathing, swallowing, and sucking difficulties. Endoscopic resection of the aryepiglottic folds, with or without the use of a carbon dioxide laser, resulted in rapid improvement of both ventilation and swallowing. The success rate of this simple and effective procedure, which has no inherent morbidity, was 98% in an average follow-up period of 30 months. Only seven children required an additional similar procedure. The procedure failed in only two children, who needed to be tracheotomized. Given these excellent results, endoscopic resection can be considered an effective technique for the management of severe laryngomalacia.