Aspiration following CO(2) laser-assisted supraglottoplasty.
OBJECTIVE
To review the incidence, risk factors, and treatment of aspiration following CO(2) laser-assisted supraglottoplasty for severe laryngomalacia (LM).


METHODS
IRB approved retrospective study of pediatric patients with severe LM treated with CO(2) laser supraglottoplasty over a 5-year period.


METHODS
Tertiary pediatric hospital.


METHODS
Fifty-two patients met inclusion criteria. Indication for supraglottoplasty was respiratory distress in 90% of patients and/or failure to thrive in 19%.


METHODS
All children underwent bilateral CO(2) laser supraglottoplasty and were assessed postoperatively with swallow evaluation by a speech pathologist. Videoflouroscopic evaluation was utilized to confirm aspiration and guide management.


METHODS
Aspiration, treatment required to manage aspiration, duration of treatment required.


RESULTS
Thirty-seven percent (20/52) of patients had postoperative aspiration. Aspiration was demonstrated on videoflouroscopic swallow study (VFSS) after supraglottoplasty is 28% (12/43). All patients with newly diagnosed aspiration had treatment with thickened and/or nasogastric feedings with mean resolution time of 6 months. In nine children with preoperative aspiration, eight (89%) had postoperative aspiration and seven required gastrostomy tube placement for feeding management. All individuals requiring gastrostomy for aspiration management had neurological conditions. In the absence of preoperative clinically evident aspiration, children with neurological conditions have an equivalent rate of postoperative aspiration as healthy children. The only risk factor for postoperative aspiration was preoperative aspiration.


CONCLUSIONS
Aspiration is more common after CO(2) laser-assisted supraglottoplasty than previously recognized. In otherwise healthy children, postoperative aspiration is of short duration and can be treated with conservative measures. Optimal treatment after supraglottoplasty includes screening for and management of aspiration in conjunction with a speech pathologist.
Schroeder
James W
JW
Department of Otolaryngology, University of Illinois at Chicago, IL, USA. jschroeder@childrensmemorial.org
Thakkar
Kunal H
KH
Poznanovic
Sheri A
SA
Holinger
Lauren D
LD
D002675:Child, Preschool; D005471:Fluoroscopy; D005931:Glottis / Q000601:surgery*; D006801:Humans; D007223:Infant; D007818:Laryngeal Diseases / Q000601:surgery*; D053685:Laser Therapy; D054020:Lasers, Gas; D011183:Postoperative Complications; D053120:Respiratory Aspiration / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012307:Risk Factors; D014741:Video Recording