Histological insight into the pathogenesis of severe laryngomalacia.
OBJECTIVE
To correlate clinical and histological findings in patients with laryngomalacia who required surgical intervention.


METHODS
Retrospective study of all patients undergoing supraglottoplasty by a single surgeon (MEG) for severe laryngomalacia between October, 1999 and November, 2000.


RESULTS
Nine patients were identified, of which seven had clinical evidence of GER. Seven patients had co-existing abnormalities or delays of neuromuscular development including seizure disorder, agenesis of the corpus callosum, obstructive sleep apnea, primary aspiration, a history of apparent life-threatening events, and craniosynostosis. Varying degrees of subepithelial edema and significant dilation of the subepithelial lymphatics were noted in all specimens. Submucosal inflammation was minimal to mild, and intraepithelial inflammation was rare to absent in all sections. No submucosal gland hyperplasia was seen in the samples from any patient. Two specimens contained cuneiform cartilage, both of which were histologically characterized as fibrocartilage.


CONCLUSIONS
In this series, the histopathology of tissue excised during the treatment of severe laryngomalacia was dominated by submucosal edema and lymphatic dilation. Further study is needed to investigate comorbidities that may contribute to the need for intervention in children with laryngomalacia.
Chandra
R K
RK
Department of Otolaryngology-Head and Neck Surgery, Children's Memorial Hospital, Northwestern University Medical School, Chicago, IL, USA. krchandra@aol.com
Gerber
M E
ME
Holinger
L D
LD
D004825:Epiglottis / Q000601:surgery; D005260:Female; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007818:Laryngeal Diseases / Q000150:complications / Q000473:pathology* / Q000601:surgery; D007820:Laryngeal Mucosa / Q000473:pathology*; D008297:Male; D009468:Neuromuscular Diseases / Q000150:complications; D012135:Respiratory Sounds / Q000209:etiology; D012189:Retrospective Studies