Laryngomalacia is repoted as the most common cause of congenital stridor. The majority of cases have mild symptom and do not require surgical intervention. However, in approximately 10 per cent of these infants the condition is life-threatening. The standard treatment for these patients has been to perform a tracheostomy. Recent reports have shown encouraging results following endoscopic surgery to the supraglottic structures. We report a case of patient in whom a tracheostomy was avoided by performing an CO2 laser microsurgeries on supraglottis.
Humans ; Infant ; Laryngomalacia* ; Lasers, Gas ; Microsurgery ; Respiratory Sounds ; Tracheostomy

Although laryngomalacia is the most common cause of congenital stridor in infancy, it is a benign, self-limited disease which usually resolves by the age of 18 months with no long- term sequelae. Nevertheless, infants who suffered from recurrent stridor and respiratory distress should be evaluated for other causes of stridor such as cardiopulmonary anomalies. We report 3 cases of infants who had recurrent stridor and respiratory distress from their early infancy. Case 1 had a double aortic arch and a tracheomalacia, case 2 had a hypoplasia of the right lung, and case 3 had a horseshoe lung as well as scimitar syndrome. Physicians should be alert for the possibility of the congenital cardiopulmonary abnormalities in infants with recurrent stridor and/or respiratory distress.
Aorta, Thoracic ; Dyspnea ; Humans ; Infant ; Laryngomalacia ; Lung ; Respiratory Sounds ; Scimitar Syndrome ; Tracheomalacia

Collapse of epiglottis during inspiration is an unusual cause of upper airway obstruction. It is usually classified as a congenital anomaly but several acquired cases have been reported to occur in patients who have lost pharyngeal airway support by head injury and coma. Recently, we experienced a case of laryngomalacia that was associated with diabetic ketoacidosis and compromised the airway. A tracheotomy was first needed to maintain the respiration, then conservative management including diabetes control was enough to restore the patient's condition. This case supports the neuromuscular dysfunction theory which purports laryngomalacia as its cause.
Airway Obstruction ; Coma ; Craniocerebral Trauma ; Diabetic Ketoacidosis* ; Epiglottis ; Humans ; Laryngomalacia* ; Respiration ; Tracheotomy

OBJECTIVE: Laryngomalacia is the most common cause for stridor in neonate and infant. Our study aims at assessing the outcome of surgical management in patients diagnosed by fibrolaryngoscope as congenital Laryngomalacia. METHOD: Retrospective study of 16 patients undergoing surgery for severe laryngomalacia. The patients' symptoms, associated medical conditions and surgical management were recorded. RESULT: Stridor and feeding difficulty were observed in 16 patients on admission, while dyspnea was found in 11 patients. Medical co-morbidities exist in 14 cases. The mean age of surgery was 23 weeks, 15 patients had follow-up records for 24 months. Fourteen cases underwent supraglortoplasty. Tracheotomy was performed on the other 2 cases complicated with tracheomalacia. Nine cases showed full recovery of stridor 48 hours post-supraglottoplasty, and 7 were free of feeding difficulties. In the 6 months follow-up, complete or partial relief was achieved in all main symptoms and signs. CONCLUSION Supraglottoplasty is effective in relieving stridor and feeding difficulty as well as respiratory insufficiency, which makes it a first line option for managing severe laryngomalacia.
Child, Preschool ; Female ; Glottis ; Humans ; Infant ; Laryngomalacia ; congenital ; surgery ; Male ; Retrospective Studies ; Treatment Outcome

Laryngomalacia is the most common congenital laryngeal anomaly. Usually, the symptoms of laryngomalacis are mild and the disease does not interfere with the general body growth as it resolves itself spontaneously. Occasionally, however, it causes a failure to grow, apnea or cardiopulmonary diseases. We have recently experienced a case of severe laryngomalacia neonate. Aryepiglottoplasty with apnea technique was carried out under the general anesthesia using CO2 Laser.
Anesthesia, General ; Apnea ; Congenital Abnormalities ; Humans ; Infant, Newborn ; Laryngomalacia ; Lasers, Gas

Laryngomalacia is reported as the most common cause of congenital laryngeal stridor. Despite its benign and self-limited aspects, 10% of all cases require intervention. However, endolaryngeal surgery in neonates makes great demands on the anesthesiologist and the surgeon because of the narrowness of the airways. This case report will present a surgical management of severe laryngomalacia in a newborn using the combination carbon dioxide laser and cold instrument to surgically divide the aryepiglottic fold under conventional ventilation.
Humans ; Infant, Newborn ; Intubation, Intratracheal ; Laryngomalacia* ; Lasers, Gas ; Respiratory Sounds ; Ventilation*

OBJECTIVES: Diagnosis and clinical presentation of pediatric laryngopharyngeal reflux (LPR) is still controversial. The aims of this work were to study the possibility of performing 24-hour oropharyngeal pH monitoring for children in the outpatient clinic setup and to explore the results of this test in correlation to airway-related problems. METHODS: In this descriptive qualitative study, 26 children suffering from airway-related problems were included. Oropharyngeal 24-hour pH monitoring was performed for all subjects in the outpatient clinic setting. The distribution of airway diagnoses among the study group was studied versus the results of the pH monitoring. RESULTS: There were 16 males and 10 females participated in the study with a mean age of 6.88 (SD, ±5.77) years. Thirty-five percent of the patients were under the age of 3 years (range, 11 months to 3 years). Eight-five percent of the patients tolerated the pH probe insertion and completed 24-hour of pH recording. Laryngomalacia and subglottic stenosis (SGS) were more frequently reported in the positive LPR patients (77%). CONCLUSION: Oropharyngeal 24-hour pH monitoring can be conducted for children in the outpatient setup even in young age children below 3 years old. Among the positive LPR group, SGS and laryngomalacia were the most commonly reported airway findings.
Airway Obstruction ; Ambulatory Care Facilities ; Child* ; Constriction, Pathologic ; Diagnosis ; Female ; Humans ; Hydrogen-Ion Concentration* ; Laryngomalacia ; Laryngopharyngeal Reflux ; Male ; Outpatients ; Pediatrics

Laryngomalacia is the most common congenital anomaly that causes inspiratory stridor and airway obstruction in the newborn. Symptoms begin to appear after weeks of age, become worse at 4-8 months, improve between 8-12 months, and usually heal naturally at 12-18 months. Despite these common natural processes, the symptoms of the disease can be very diverse and, in severe cases, require surgical treatment. The diagnosis can be made by suspicion of clinical symptoms and direct observation of the larynx with the spontaneous breathing of the child. Typical laryngeal features include omega-shaped epiglottis, retroflexed epiglottis, short aryepiglottic fold, poor visualization of the vocal folds, and edema of the posterior glottis, including inspiratory supra-arytenoid tissue prolapse. In this review, we discuss the classification and treatment based on symptoms and laryngoscopic findings in patients with laryngomalacia.
Airway Obstruction ; Child ; Classification* ; Comorbidity ; Diagnosis ; Edema ; Epiglottis ; Glottis ; Humans ; Infant, Newborn ; Laryngomalacia* ; Larynx ; Prolapse ; Respiration ; Respiratory Sounds ; Vocal Cords

OBJECTIVETo evaluate the feasibility and safety of CO2 laser supraglottoplasty for severe laryngomalacia in infants.

METHODSFrom January 2009 to December 2011, 32 infants with severe laryngomalacia were confirmed by electronic laryngoscope and clinical assessment in Shenzhen Children's Hospital. According to the choice made by the parents, 16 children accepted CO2 laser supraglottoplasty (group 1), the others were treated conservatively (group 2). The beginning observation point T0 was defined as the age on the first medicine taking day or the age of surgery. T1, T3, T6 were defined as 1, 3, 6 months following T0. Clinical symptoms included stridor, dyspnea, aspiration, and respiratory infections. The body weight, PSG reports, laryngoscope findings, cure rates of the two groups were compared.

RESULTSThe anatomical abnormalities were corrected surgically, and the symptoms ,such as stridor, dyspnea, and aspiration improved rapidly after the operation. The cure rates was higher in group 1 than in group 2 on T1, T3, T6 stage. There were statistically significant differences(χ(2) were 13.9, 28.1, 24.6 respectively; all P < 0.01). Children in group 1 gained weight better than in group 2. There was a statistically significant difference in Z scores median on T1, T3, T6 stage (z score were -0.848, -2.940, -4.110; P < 0.05, or P < 0.01 respectively). The lowest oxygen saturation in group 1 improved one month after the surgery (from average 0.686 ± 0.106 to 0.901 ± 0.041). There was a statistically significant difference (t = -7.876, P = 0.001). Complications included adhesion (1 case) and temporary new-onset aspiration (1 case).

CONCLUSIONSThe CO2 laser supraglottoplasty can resolve severe laryngomalacia symptoms including stridor, dyspnea and aspiration. It can reduce the frequency of respiratory infections, and contribute to weight gaining. The CO2 laser supraglottoplasty is effective, of high security and with rare complications.

Carbon Dioxide ; Glottis ; Humans ; Infant ; Infant, Newborn ; Laryngomalacia ; radiotherapy ; Laryngoscopes ; Lasers, Gas ; therapeutic use ; Low-Level Light Therapy ; Retrospective Studies

Congenital laryngomalacia is the most common disease causing laryngeal stridor in infants. The pathogenesis has not yet been clearly concluded. It may be related to abnormal development of laryngeal cartilage anatomical structure, neuromuscular dysfunction, gastroesophageal and laryngeal reflux disease, etc. The typical manifestations of the disease are inspiratory laryngeal stridor and feeding difficulties, which can be divided into mild, moderate and severe according to the severity of symptoms. The diagnosis is mainly based on clinical symptoms, signs and endoscopy, among which endoscopy is an important diagnostic basis. The treatment of laryngomalacia depends on the severity of symptoms. Mild and some moderate congenital laryngomalacia children can be relieved by conservative treatment, and severe and some moderate congenital laryngomalacia children should be treated by surgery. Supraglottic plasty is the main surgical method, which can effectively improve the symptoms of laryngeal stridor, dyspnea, feeding difficulties and growth retardation in most children, and the surgical effect is good.
Infant ; Child ; Humans ; Laryngomalacia/therapy* ; Respiratory Sounds/etiology* ; Larynx/surgery* ; Laryngeal Diseases/surgery* ; Endoscopy/adverse effects* ; Laryngismus