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Abstract
Laryngomalacia is the most common cause of stridor in infants. Severely affected children are at risk of feeding difficulties, apnoeic episodes and cor pulmonale secondary to upper airway obstruction. The aim of this study was to assess the outcome of aryepiglottoplasty. This is a simple surgical procedure that relieves the obstruction by dividing the aryepiglottic folds. Thirty children had an aryepiglottoplasty at the Royal Liverpool Children's Hospital between January 1995 and June 2001. The case notes of all 30 children were reviewed for age, sex, age at operation, indications, operative technique, complications and long-term outcomes. Complete resolution of stridor was obtained in 83 per cent of patients, with an improvement in a further 7 per cent. Post-operative complications included lower respiratory tract infections (13 per cent) and vomiting (7 per cent). In conclusion, simple endoscopic aryepiglottoplasty remains an effective way of treating upper airway obstruction in children. Its high resolution and low complication rate make it a safe, first choice procedure for treatment of moderate to severe laryngomalacia.
Key words: Laryngeal Cartilages/Surgery; Airway Obstruction; Endoscopy
Introduction
Laryngomalacia is the most common cause of stridor in infants and neonates. It is usually present at birth, but may take weeks to develop, becoming most severe by the age of six months, and resolving between 18 and 24 months.1 Essentially, stridor is caused by prolapse of the supraglottic structures in the larynx on inspiration. The severity is variable and most marked when the child is feeding, agitated, or has an upper respiratory tract infection. Laryngomalacia may be divided into three types based on the site of the supraglottic obstruction: Type 1 includes the prolapse of the mucosa overlying the arytenoid cartilages, Type 2 involves foreshortened aryepiglottic folds, and in Type 3 there is posterior displacement of the epiglottis23 (Figure 1). Most cases are mild, need no surgical intervention, and will resolve spontaneously. In more severe cases, stridor is accompanied by tachypnoea, trachéal tug and sternal recession, feeding difficulties and failure to thrive. These children are also at risk of apnoeic episodes and cor pulmonale secondary to upper airway obstruction. Such children account for 10 per cent of cases of laryngomalacia4 and will require surgical intervention. Traditionally, the only surgery available was a tracheostomy, but the associated...