title: Transient swallowing dysfunction in typically developing children following supraglottoplasty for laryngomalacia.
abstract: OBJECTIVE
  To evaluate early postoperative swallowing function in otherwise typically-developing children following supraglottoplasty.
  
  
  METHODS
  Retrospective chart review case series.
  
  
  RESULTS
  Of 37 children identified as having undergone supraglottoplasty for severe laryngomalacia at our institution between January 2007 and October 2011, 24 were identified as otherwise typically developing with no indications/signs of swallowing problems pre-operatively and eligible for inclusion in this study. Twenty-two children underwent bilateral supraglottoplasty and 2 children underwent unilateral supraglottoplasty using the CO2 laser or the laryngeal skimmer microdebrider in combination with cold steel technique, based on the discretion of four Pediatric Otolaryngologists. Seventeen children were seen post-operatively for a clinical swallow evaluation. Six children were found to have swallowing dysfunction. Four of the six children showed variable symptoms, signs, or findings concerning for aspiration with oral feeding. Three of six underwent video fluoroscopic swallow study (VFSS). All 6 children responded to dietary modifications, positioning alterations, and anti-reflux medications. All showed improvement by their 4-week post-operative follow-up visit. The median age of the 24 patients at the time of surgery was 3 months, with a range from 2 weeks to 4 years. The median age of the patients found to have transient post-operative swallowing dysfunction was 1.5 months, with a range of 2 weeks to 4 months. There was no association between post-operative swallowing dysfunction and the surgical technique employed.
  
  
  CONCLUSIONS
  Supraglottoplasty in otherwise typically developing children carries a risk of transient swallowing dysfunction with a low risk of persistent dysfunction. Most patients can be assessed post-operatively via clinical swallow evaluation without requiring an instrumental swallow study.
authors.affiliation: Department of Otolaryngology, Division of Pediatric Otolaryngology, Medical College of Wisconsin, United States. Electronic address: Rchun@mcw.edu.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Chun
authors.affiliation: Department of Otolaryngology, Division of Pediatric Otolaryngology, Medical College of Wisconsin, United States.
authors.forename: Maria
authors.initials: M
authors.lastname: Wittkopf
authors.affiliation: Department of Otolaryngology, Division of Pediatric Otolaryngology, Medical College of Wisconsin, United States.
authors.forename: Cecille
authors.initials: C
authors.lastname: Sulman
authors.affiliation: Department of Pediatrics, Division of Gastroenterology, Medical College of Wisconsin, United States; Speech Pathology and Audiology Children's Hospital of Wisconsin, United States.
authors.forename: Joan
authors.initials: J
authors.lastname: Arvedson
mesh_terms: D002675:Child, Preschool; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D055092:Laryngomalacia / Q000601:surgery*; D058753:Laryngoplasty / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D008297:Male; D020127:Recovery of Function; D012189:Retrospective Studies
keywords: Aspiration; Dysphagia; Laryngomalacia; Supraglottoplasty