European Archives of Oto-Rhino-Laryngology

, Volume 274, Issue 1, pp 367–374 | Cite as

Laser supraglottoplasty for laryngomalacia; a 14 year experience of a tertiary referral center

  • Antoine Reinhard
  • François Gorostidi
  • Crispin Leishman
  • Philippe Monnier
  • Kishore Sandu
Laryngology

Abstract

To review the outcomes of laser supraglottoplasty performed in children with symptomatic laryngomalacia and determine the factors influencing them. We retrospectively reviewed the medical records of patients who underwent laser supraglottoplasty for symptomatic laryngomalacia at the Lausanne University Hospital from November 2001 to November 2014. We examined the patient’s demography, symptoms, comorbidities, type of laryngomalacia, synchronous airway lesions, and final outcomes. Seventy-nine patients were included in this study; median age at the time of surgery was 12.7 months. 55.7 % of the cases had comorbidities, 22.8 % of the patients were premature and synchronous airway lesions were present in 32.9 % of the cases. The different morphological types of laryngomalacia (I–III) were seen in 26.6, 62 and 11.4 % of the patients, respectively. Overall, operation specific success rate of laser supraglottoplasty was 86.1 %. Failures in 11 (13.9 %) of the 79 cases required 15 revision procedures. Success rates for patients with associated comorbidities, synchronous airway lesions, neurological disorders and prematurity were 81.8, 76.9, 69.2 and 66.7 %, respectively. Patients with type III laryngomalacia had a limited success rate (66.7 %) as compared to patients with morphological types I and II (90.5 and 87.8 %, respectively). Laser supraglottoplasty is an effective and safe treatment for symptomatic laryngomalacia. Patients with prematurity, type III LM, synchronous airway lesions and associated comorbidities are predisposed to surgical failure.

Keywords

Laryngomalacia Laser Supraglottoplasty Pediatric airway Stridor 

Notes

Compliance with ethical standards

Funding

None.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of our institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study (retrospective study) formal consent is not required.

References

  1. 1.
    Daniel SJ (2006) The upper airway: congenital malformations. Paediatr Respir Rev 7(Suppl 1):S260–S263CrossRefPubMedGoogle Scholar
  2. 2.
    Kay DJ, Goldsmith AJ (2006) Laryngomalacia: a classification system and surgical treatment strategy. Ear Nose Throat J 5(5):328–331, 336Google Scholar
  3. 3.
    Manning SC, Inglis AF, Mouzakes J, Carron J, Perkins JA (2005) Laryngeal anatomic differences in pediatric patients with severe laryngomalacia. Arch Otolaryngol Head Neck Surg 131(4):340–343CrossRefPubMedGoogle Scholar
  4. 4.
    Chandra RK, Gerber ME, Holinger LD (2001) Histological insight into the pathogenesis of severe laryngomalacia. Int J Pediatr Otorhinolaryngol 61(1):31–38CrossRefPubMedGoogle Scholar
  5. 5.
    Thompson DM (2007) Abnormal sensorimotor integrative function of the larynx in congenital laryngomalacia: a new theory of etiology. Laryngoscope 117(6 Pt 2 Suppl 114):1–33CrossRefPubMedGoogle Scholar
  6. 6.
    Bibi H, Khvolis E, Shoseyov D et al (2001) The prevalence of gastroesophageal reflux in children with tracheomalacia and laryngomalacia. Chest 119(2):409–413CrossRefPubMedGoogle Scholar
  7. 7.
    Hartl TT, Chadha NK (2012) A systematic review of laryngomalacia and acid reflux. Otolaryngol Head Neck Surg 147(4):619–626CrossRefPubMedGoogle Scholar
  8. 8.
    Roger G, Denoyelle F, Triglia JM, Garabedian EN (1995) Severe laryngomalacia: surgical indications and results in 115 patients. Laryngoscope 105(10):1111–1117CrossRefPubMedGoogle Scholar
  9. 9.
    Olney DR, Greinwald JH, Smith RJ, Bauman NM (1999) Laryngomalacia and its treatment. Laryngoscope 109(11):1770–1775CrossRefPubMedGoogle Scholar
  10. 10.
    Lee K-S, Chen B-N, Yang C-C, Chen Y-C (2007) CO2 laser supraglottoplasty for severe laryngomalacia: a study of symptomatic improvement. Int J Pediatr Otorhinolaryngol 71(6):889–895CrossRefPubMedGoogle Scholar
  11. 11.
    Holinger LD, Konior RJ (1989) Surgical management of severe laryngomalacia. Laryngoscope 99(2):136–142CrossRefPubMedGoogle Scholar
  12. 12.
    Shah UK, Wetmore RF (1998) Laryngomalacia: a proposed classification form. Int J Pediatr Otorhinolaryngol 46(1–2):21–26CrossRefPubMedGoogle Scholar
  13. 13.
    Landry AM, Thompson DM (2012) Laryngomalacia: disease presentation, spectrum, and management. Int J Pediatr 2012:753526CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Ayari S, Aubertin G, Girschig H et al (2013) Management of laryngomalacia. Eur Ann Otorhinolaryngol Head Neck Dis 130(1):15–21CrossRefPubMedGoogle Scholar
  15. 15.
    Richter GT, Thompson DM (2008) The surgical management of laryngomalacia. Otolaryngol Clin N Am 41(5):837–864, viiGoogle Scholar
  16. 16.
    Toynton SC, Saunders MW, Bailey CM (2001) Aryepiglottoplasty for laryngomalacia: 100 consecutive cases. J Laryngol Otol 115(1):35–38CrossRefPubMedGoogle Scholar
  17. 17.
    Preciado D, Zalzal G (2012) A systematic review of supraglottoplasty outcomes. Arch Otolaryngol Head Neck Surg 138(8):718–721CrossRefPubMedGoogle Scholar
  18. 18.
    Day KE, Discolo CM, Meier JD, Wolf BJ, Halstead LA, White DR (2012) Risk factors for supraglottoplasty failure. Otolaryngol Head Neck Surg 146(2):298–301CrossRefPubMedGoogle Scholar
  19. 19.
    Denoyelle F, Mondain M, Gresillon N, Roger G, Chaudre F, Garabedian EN (2003) Failures and complications of supraglottoplasty in children. Arch Otolaryngol Head Neck Surg 129(10):1077–1080 (discussion 1080) CrossRefPubMedGoogle Scholar
  20. 20.
    Thompson DM (2010) Laryngomalacia: factors that influence disease severity and outcomes of management. Curr Opin Otolaryngol Head Neck Surg 18(6):564–570CrossRefPubMedGoogle Scholar
  21. 21.
    Durvasula VSPB, Lawson BR, Bower CM, Richter GT (2014) Supraglottoplasty outcomes in neurologically affected and syndromic children. JAMA Otolaryngol Head Neck Surg 140(8):704–711CrossRefPubMedGoogle Scholar
  22. 22.
    Escher A, Probst R, Gysin C (2015) Management of laryngomalacia in children with congenital syndrome: the role of supraglottoplasty. J Pediatr Surg 50(4):519–523CrossRefPubMedGoogle Scholar
  23. 23.
    Senders CW, Navarrete EG (2001) Laser supraglottoplasty for laryngomalacia: are specific anatomical defects more influential than associated anomalies on outcome? Int J Pediatr Otorhinolaryngol 57(3):235–244CrossRefPubMedGoogle Scholar
  24. 24.
    Schroeder JW, Bhandarkar ND, Holinger LD (2009) Synchronous airway lesions and outcomes in infants with severe laryngomalacia requiring supraglottoplasty. Arch Otolaryngol Head Neck Surg 135(7):647–651CrossRefPubMedGoogle Scholar
  25. 25.
    Sandu K, Monnier P, Reinhard A, Gorostidi F (2015) Endoscopic epiglottopexy using Lichtenberger’s needle carrier to avoid breakdown of repair. Eur Arch Otorhinolaryngol 272(11):3385–3390CrossRefPubMedGoogle Scholar
  26. 26.
    Gonzalez C, Reilly JS, Bluestone CD (1987) Synchronous airway lesions in infancy. Ann Otol Rhinol Laryngol 96(1 Pt 1):77–80CrossRefPubMedGoogle Scholar
  27. 27.
    Mancuso RF, Choi SS, Zalzal GH, Grundfast KM (1996) Laryngomalacia. The search for the second lesion. Arch Otolaryngol Head Neck Surg 122(3):302–306CrossRefPubMedGoogle Scholar
  28. 28.
    Yuen H-W, Tan HK-K, Balakrishnan A (2006) Synchronous airway lesions and associated anomalies in children with laryngomalacia evaluated with rigid endoscopy. Int J Pediatr Otorhinolaryngol 70(10):1779–1784CrossRefPubMedGoogle Scholar
  29. 29.
    Erickson B, Cooper T, El-Hakim H (2014) Factors associated with the morphological type of laryngomalacia and prognostic value for surgical outcomes. JAMA Otolaryngol Head Neck Surg 140(10):927–933CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Antoine Reinhard
    • 1
  • François Gorostidi
    • 1
  • Crispin Leishman
    • 1
  • Philippe Monnier
    • 1
  • Kishore Sandu
    • 1
  1. 1.Department of OtorhinolaryngologyCentre Hospitalier Universitaire Vaudois1011 LausanneSwitzerland

Personalised recommendations