Polysomnography outcomes following transoral CO2 laser microsurgery in pediatric patients with laryngomalacia.
OBJECTIVE
Laryngomalacia is the most common cause of stridor in newborns and infants. The aim of the contribution was to present objectified data of the outcome of transoral CO(2) laser microsurgery in patients with laryngomalacia utilizing polysomnography (PSG).


METHODS
This retrospective study comprised 21 patients who were diagnosed to suffer from laryngomalacia. Diagnosis was confirmed by pharyngo-laryngoscopy under spontaneous breathing. If there was evidence for laryngomalacia a transoral CO(2) lasersurgical intervention and/or epiglottopexy was performed in the same session. 8 patients, on whom the following should be focused, received pre- and postoperative PSG which was performed for efficiency control of the applied treatment.


RESULTS
All 21 patients underwent invasive treatment for laryngomalacia (lasersurgical division of the aryepiglottic folds: n=13; epiglottopexy: n=5; combined procedure: n=3). All patients were successfully extubated after surgery. In 20/21 cases breathing improved clearly after one single intervention. Stridor disappeared completely in the further course of the disease. In the 8 patients who received pre- and postinterventional PSG, lasersurgical interventions were performed. Statistical analysis of pre- and postoperative PSG revealed that MOAI/h (mixed obstructive apnea index/hour) improved significantly (p=0.016, Wilcoxon-Signed-Rank Test). Also desaturation/hour improved in the postoperative course (p=0.11).


CONCLUSIONS
The presented concept describes an effective and reliable approach for diagnostics and treatment for laryngomalacia. To objectify the success of supraglottoplaty in patients suffering from severe laryngomalacia a pre- and postoperative PSG seems to be useful and advisable. The present results of PSG demonstrate that children with laryngomalacia to benefit from lasersurgical division of the aryepiglottic folds and/or epiglottopexy. This fact is supported by the postoperative improved clinical aspect.
Sesterhenn
Andreas M
AM
Department of Otolaryngology, Head & Neck Surgery, University Hospital of Giessen and Marburg, Campus Marburg, Deutschhausstrasse 3, D-35037 Marburg, Germany. sesterhe@med.uni-marburg.de
Zimmermann
Annette P
AP
Bernhard
Michael
M
Kussin
Andrea
A
Timmesfeld
Nina
N
Stiller
Susanne
S
Wiegand
Susanne
S
Maier
Rolf F
RF
Werner
Jochen A
JA
D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D055092:Laryngomalacia / Q000151:congenital / Q000175:diagnosis* / Q000601:surgery*; D007828:Laryngoscopy / Q000379:methods; D053685:Laser Therapy / Q000379:methods*; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods*; D017286:Polysomnography / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome