Laser supraglottoplasty for laryngomalacia: Are specific anatomical defects more influential than associated anomalies on outcome?

Craig W Senders, Enrique G. Navarrete

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Objective: To evaluate different CO2 laser procedures on children with various types of laryngomalacia and determine the role of associated anomalies on the outcome. Design: Retrospective chart review. Setting: Academic tertiary referral center. Patients: Twenty-three children who underwent laser supraglottoplasty for laryngomalacia between 1991 and 1998 at the UC Davis Medical Center. Interventions: CO2 laser vaporization of redundant supraglottic mucosa of the aryepiglottic fold, arytenoid, and the epiglottis, or modification of the latter, either individually or in combination, based on the obstructing anatomy. Outcome measures: Immediate, short term, intermediate and long term relief of respiratory symptoms, feeding difficulties, effect of associated anomalies on outcome, effect of specific anatomic obstructing site and surgical procedure performed on outcome, and the incidence of complications inherent to the procedure. Results: Children without associated anomalies invariably did very well, with 78% immediately resolving their respiratory symptoms and 100% within a week. Twelve of the 14 patients with unfavorable immediate results (P<0.01) and all ten with short term unfavorable results (P<0.05) had neurologic or anatomic associated anomalies. Seven patients, all with associated anomalies, were considered surgical failures (P<0.05). These patients also had a significantly longer hospital stay (P<0.01). The presence of associated anomalies was significant (P<0.01) in determining surgical treatment of reflux or the need for an NG tube in treating feeding problems. The anatomic site of abnormality and the specific procedure performed did not affect the outcome. There were no serious complications inherent to this procedure. Conclusions: Laser supraglottoplasty, in its different modalities, is a safe and effective treatment for all types of laryngomalacia, but children with associated neurologic or anatomic anomalies will have a more complicated immediate and short term course, as well as a significant incidence of failure. Gastroesophageal reflux is an important associated condition that requires investigation in these patients, and in severe cases will merit surgical procedures to manage. The high incidence of associated neuromuscular anomalies suggests that this component has an important role in the etiology of laryngomalacia.

Original languageEnglish (US)
Pages (from-to)235-244
Number of pages10
JournalInternational Journal of Pediatric Otorhinolaryngology
Volume57
Issue number3
DOIs
StatePublished - Mar 1 2001

Fingerprint

Laryngomalacia
Lasers
Gas Lasers
Nervous System
Incidence
Epiglottis
Laser Therapy
Gastroesophageal Reflux
Tertiary Care Centers
Curriculum
Length of Stay
Anatomy
Mucous Membrane
Outcome Assessment (Health Care)
Therapeutics

Keywords

  • Associated anomalies
  • CO2 laser
  • Epiglottopexy
  • Failure to thrive
  • Gastroesophageal reflux
  • Laryngomalacia
  • Stridor
  • Supraglottoplasty

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Pediatrics, Perinatology, and Child Health
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

@article{12b88ae99b094cf4ac0c453718e8e7a4,
title = "Laser supraglottoplasty for laryngomalacia: Are specific anatomical defects more influential than associated anomalies on outcome?",
abstract = "Objective: To evaluate different CO2 laser procedures on children with various types of laryngomalacia and determine the role of associated anomalies on the outcome. Design: Retrospective chart review. Setting: Academic tertiary referral center. Patients: Twenty-three children who underwent laser supraglottoplasty for laryngomalacia between 1991 and 1998 at the UC Davis Medical Center. Interventions: CO2 laser vaporization of redundant supraglottic mucosa of the aryepiglottic fold, arytenoid, and the epiglottis, or modification of the latter, either individually or in combination, based on the obstructing anatomy. Outcome measures: Immediate, short term, intermediate and long term relief of respiratory symptoms, feeding difficulties, effect of associated anomalies on outcome, effect of specific anatomic obstructing site and surgical procedure performed on outcome, and the incidence of complications inherent to the procedure. Results: Children without associated anomalies invariably did very well, with 78{\%} immediately resolving their respiratory symptoms and 100{\%} within a week. Twelve of the 14 patients with unfavorable immediate results (P<0.01) and all ten with short term unfavorable results (P<0.05) had neurologic or anatomic associated anomalies. Seven patients, all with associated anomalies, were considered surgical failures (P<0.05). These patients also had a significantly longer hospital stay (P<0.01). The presence of associated anomalies was significant (P<0.01) in determining surgical treatment of reflux or the need for an NG tube in treating feeding problems. The anatomic site of abnormality and the specific procedure performed did not affect the outcome. There were no serious complications inherent to this procedure. Conclusions: Laser supraglottoplasty, in its different modalities, is a safe and effective treatment for all types of laryngomalacia, but children with associated neurologic or anatomic anomalies will have a more complicated immediate and short term course, as well as a significant incidence of failure. Gastroesophageal reflux is an important associated condition that requires investigation in these patients, and in severe cases will merit surgical procedures to manage. The high incidence of associated neuromuscular anomalies suggests that this component has an important role in the etiology of laryngomalacia.",
keywords = "Associated anomalies, CO2 laser, Epiglottopexy, Failure to thrive, Gastroesophageal reflux, Laryngomalacia, Stridor, Supraglottoplasty",
author = "Senders, {Craig W} and Navarrete, {Enrique G.}",
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TY - JOUR

T1 - Laser supraglottoplasty for laryngomalacia

T2 - Are specific anatomical defects more influential than associated anomalies on outcome?

AU - Senders, Craig W

AU - Navarrete, Enrique G.

PY - 2001/3/1

Y1 - 2001/3/1

N2 - Objective: To evaluate different CO2 laser procedures on children with various types of laryngomalacia and determine the role of associated anomalies on the outcome. Design: Retrospective chart review. Setting: Academic tertiary referral center. Patients: Twenty-three children who underwent laser supraglottoplasty for laryngomalacia between 1991 and 1998 at the UC Davis Medical Center. Interventions: CO2 laser vaporization of redundant supraglottic mucosa of the aryepiglottic fold, arytenoid, and the epiglottis, or modification of the latter, either individually or in combination, based on the obstructing anatomy. Outcome measures: Immediate, short term, intermediate and long term relief of respiratory symptoms, feeding difficulties, effect of associated anomalies on outcome, effect of specific anatomic obstructing site and surgical procedure performed on outcome, and the incidence of complications inherent to the procedure. Results: Children without associated anomalies invariably did very well, with 78% immediately resolving their respiratory symptoms and 100% within a week. Twelve of the 14 patients with unfavorable immediate results (P<0.01) and all ten with short term unfavorable results (P<0.05) had neurologic or anatomic associated anomalies. Seven patients, all with associated anomalies, were considered surgical failures (P<0.05). These patients also had a significantly longer hospital stay (P<0.01). The presence of associated anomalies was significant (P<0.01) in determining surgical treatment of reflux or the need for an NG tube in treating feeding problems. The anatomic site of abnormality and the specific procedure performed did not affect the outcome. There were no serious complications inherent to this procedure. Conclusions: Laser supraglottoplasty, in its different modalities, is a safe and effective treatment for all types of laryngomalacia, but children with associated neurologic or anatomic anomalies will have a more complicated immediate and short term course, as well as a significant incidence of failure. Gastroesophageal reflux is an important associated condition that requires investigation in these patients, and in severe cases will merit surgical procedures to manage. The high incidence of associated neuromuscular anomalies suggests that this component has an important role in the etiology of laryngomalacia.

AB - Objective: To evaluate different CO2 laser procedures on children with various types of laryngomalacia and determine the role of associated anomalies on the outcome. Design: Retrospective chart review. Setting: Academic tertiary referral center. Patients: Twenty-three children who underwent laser supraglottoplasty for laryngomalacia between 1991 and 1998 at the UC Davis Medical Center. Interventions: CO2 laser vaporization of redundant supraglottic mucosa of the aryepiglottic fold, arytenoid, and the epiglottis, or modification of the latter, either individually or in combination, based on the obstructing anatomy. Outcome measures: Immediate, short term, intermediate and long term relief of respiratory symptoms, feeding difficulties, effect of associated anomalies on outcome, effect of specific anatomic obstructing site and surgical procedure performed on outcome, and the incidence of complications inherent to the procedure. Results: Children without associated anomalies invariably did very well, with 78% immediately resolving their respiratory symptoms and 100% within a week. Twelve of the 14 patients with unfavorable immediate results (P<0.01) and all ten with short term unfavorable results (P<0.05) had neurologic or anatomic associated anomalies. Seven patients, all with associated anomalies, were considered surgical failures (P<0.05). These patients also had a significantly longer hospital stay (P<0.01). The presence of associated anomalies was significant (P<0.01) in determining surgical treatment of reflux or the need for an NG tube in treating feeding problems. The anatomic site of abnormality and the specific procedure performed did not affect the outcome. There were no serious complications inherent to this procedure. Conclusions: Laser supraglottoplasty, in its different modalities, is a safe and effective treatment for all types of laryngomalacia, but children with associated neurologic or anatomic anomalies will have a more complicated immediate and short term course, as well as a significant incidence of failure. Gastroesophageal reflux is an important associated condition that requires investigation in these patients, and in severe cases will merit surgical procedures to manage. The high incidence of associated neuromuscular anomalies suggests that this component has an important role in the etiology of laryngomalacia.

KW - Associated anomalies

KW - CO2 laser

KW - Epiglottopexy

KW - Failure to thrive

KW - Gastroesophageal reflux

KW - Laryngomalacia

KW - Stridor

KW - Supraglottoplasty

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