CO2 laser supraglottoplasty for severe laryngomalacia: a study of symptomatic improvement.
OBJECTIVE
To investigate post-operative symptom improvement in patients with severe laryngomalacia.


METHODS
Severe laryngomalacia was diagnosed in 138 patients (average age of 6.97 months) by bronchoscopy. Laryngomalacia was defined by the direction of supraglottic collapse: type A (posterolateral), type B (complete), and type C (anterior). As multiple laryngomalacia types within an individual were common, patients were further categorized into group I (type A only), group II (type B or B+A), and group III (type C, C+A, or C+B+A). CO(2) laser supraglottoplasty was performed. Improvements in inspiratory stridor, suprasternal retraction, substernal retraction, feeding difficulty, choking, post-feeding vomit, failure to thrive, and cyanosis were investigated. The presence of a symptom was scored as 1, and the absence as 0. The total score of symptoms was calculated for each patient. General medical history, age at time of surgery, type of laryngomalacia, post-operative intubation period, duration in ICU and dates of postoperative admission were recorded.


RESULTS
Overall symptom improvement was observed in 82.6% of patients, with statistically significant resolution evident in group III (B-value=0.79, 95% CI: -0.01, 1.59). Symptoms were not well improved in patients with cerebral palsy (n=32, B-value=-1.02, 95% CI: -1.80, -0.25; p<0.01). The two most improved symptoms were substernal retraction and suprasternal retraction, while the two least improved symptoms were choking and feeding difficulties.


CONCLUSIONS
CO(2) laser supraglottoplasty is an effective treatment option for severe laryngomalacia, especially for group III laryngomalacia cases in the absence of cerebral palsy. It has the superiority of facilitating significant symptomatic resolution and reducing the post-operative complications.
Lee
Kuo-Sheng
KS
Department of Otolaryngology-Head and Neck surgery, Mackay Memorial Hospital, Chung-Shan North Road Section 2, Number 92, Taipei City, Taiwan. kslee147@ms31.hinet.net
Chen
Bo-Nien
BN
Yang
Cheng-Chien
CC
Chen
Yu-Chun
YC
D000367:Age Factors; D000402:Airway Obstruction / Q000503:physiopathology; D002245:Carbon Dioxide; D002547:Cerebral Palsy / Q000150:complications; D002675:Child, Preschool; D003422:Critical Care; D003490:Cyanosis / Q000503:physiopathology; D004435:Eating / Q000502:physiology; D005183:Failure to Thrive / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis / Q000601:surgery*; D006801:Humans; D007223:Infant; D001239:Inhalation / Q000502:physiology; D007441:Intubation, Gastrointestinal; D007818:Laryngeal Diseases / Q000145:classification / Q000503:physiopathology / Q000601:surgery*; D007828:Laryngoscopy; D053685:Laser Therapy; D008297:Male; D010359:Patient Readmission; D012135:Respiratory Sounds / Q000145:classification; D012189:Retrospective Studies; D013997:Time Factors; D014839:Vomiting / Q000503:physiopathology
D002245:Carbon Dioxide