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Discoordinate pharyngolaryngomalacia
P Froehlich1, A B Seid, F Denoyelle
1Département d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Hôpital E. Herriot, Lyon, France.
International Journal of Pediatric Otorhinolaryngology
|February 14, 1997
Summary
Severe laryngomalacia can resist standard endoscopic treatments. A new condition, discoordinate pharyngolaryngomalacia (DPLM), requires additional interventions beyond supraglottoplasty for effective treatment.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
- Surgical Innovation
Background:
- Severe laryngomalacia often requires intervention.
- Endoscopic supraglottoplasty is a common treatment for laryngomalacia.
- Treatment failure in severe laryngomalacia is not well understood.
Purpose of the Study:
- To describe cases of severe laryngomalacia unresponsive to endoscopic treatment.
- To introduce and define discoordinate pharyngolaryngomalacia (DPLM).
- To investigate reasons for treatment failure in severe laryngomalacia.
Main Methods:
- Retrospective review of 82 children with severe laryngomalacia.
- Definition and identification of discoordinate pharyngolaryngomalacia (DPLM).
- Analysis of treatment outcomes for DPLM cases, including additional surgical interventions and non-invasive ventilation.
Main Results:
- 27 of 82 children (33%) had DPLM, characterized by complete supraglottic collapse without shortened aryepiglottic folds (AEFs) or redundant mucosa, plus pharyngomalacia.
- Endoscopic treatment was insufficient in 16 DPLM patients.
- 10 children required additional procedures (uvulopharyngopalatoplasty, choanal atresia repair, aortopexy); 13 needed tracheostomy, while 2 successfully used Bi-level positive airway pressure (BiPAP).
Conclusions:
- Discoordinate pharyngolaryngomalacia (DPLM) represents a severe subtype of laryngomalacia.
- Standard endoscopic supraglottoplasty may be inadequate for DPLM.
- Further research is needed to define optimal treatment strategies for DPLM, potentially involving multi-level airway intervention.