title: CO2 laser supraglottoplasty for severe laryngomalacia: a study of symptomatic improvement.
abstract: 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.
authors.affiliation: 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
authors.forename: Kuo-Sheng
authors.initials: KS
authors.lastname: Lee
authors.forename: Bo-Nien
authors.initials: BN
authors.lastname: Chen
authors.forename: Cheng-Chien
authors.initials: CC
authors.lastname: Yang
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Chen
mesh_terms: 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
chemical_list: D002245:Carbon Dioxide