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Laryngomalazie

Wann ist eine Operation sinnvoll?

Laryngomalacia

When does surgery make sense?

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Zusammenfassung

Die häufigste Ursache eines Stridors im Neugeborenenalter ist eine Instabilität des Kehlkopfeingangs, welche als Laryngomalazie bezeichnet wird. Bei etwa 10% der betroffenen Kinder ist dadurch die normale Entwicklung beeinträchtigt. Die Diagnostik und die Therapie müssen einem klaren Konzept folgen und für die Eltern nachvollziehbar sein. Die Lokalisation der Obstruktion sollte endoskopisch gesichert, die anatomische Beschaffenheit des Kehlkopfs beschrieben und Möglichkeit einer chirurgischen Stabilisierung der Supraglottis geprüft werden. Weitere pathologische Veränderungen der oberen Atemwege (z. B. eine Parese der Stimmlippen) müssen ausgeschlossen werden. Die chirurgische Therapie der Laryngomalazie wird als Supraglottoplastik bezeichnet und kann die Reduktion der überschüssigen Schleimhaut im Larynxeingang, die Durchtrennung der zu kurzen aryepiglottischen Falten und im Einzelfall die Fixation der Epiglottis an den Zungengrund umfassen. In ausgeprägten Fällen kann eine Tracheotomie trotzdem unumgänglich werden. Eine Operation wird nur bei Vorliegen von schweren Beeinträchtigungen des Kindes empfohlen. Bei korrekter Indikationsstellung ist mit einer Erfolgsquote von über 90% zu rechnen.

Abstract

The most common cause of stridor in newborns is instability of the upper larynx, called laryngomalacia. In approximately 10% of children normal development is impaired. The diagnostics and therapy must follow a clear plan that is also comprehensible to the parents. The obstruction should be localized endoscopically, the anatomical characteristics determined, and the surgical possibilities evaluated. Additional pathological changes of the upper airway (e.g., vocal fold paresis) need to be excluded. Surgery for laryngomalacia, called supraglottoplasty, allows reduction of excess mucus, transectioning of aryepiglottic folds that are too short, and in some cases epiglottic fixation to the base of the tongue. In extreme cases tracheotomy is unavoidable. Surgery is only recommended for severe cases; when carried out correctly according to the medical indications, the success rate is over 90%.

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  1. Abt. pädiatrische Hals-Nasen-Ohren-Heilkunde und Otologie, Klinik für Hals-Nasen-Ohren-Heilkunde, Kopf-Hals-Chirurgie, Klinikum Stuttgart, Bismarckstr. 8, 70176, Stuttgart, Deutschland

    A. Koitschev & C. Sittel

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  1. A. Koitschev
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  2. C. Sittel
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Correspondence to A. Koitschev.

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Koitschev, A., Sittel, C. Laryngomalazie. HNO 60, 573–580 (2012). https://doi.org/10.1007/s00106-011-2379-8

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