title: The groningen laryngomalacia classification system--based on systematic review and dynamic airway changes.
abstract: OBJECTIVE
  Laryngomalacia is the most common cause of dyspnea and stridor in newborn infants. Laryngomalacia is a dynamic change of the upper airway based on abnormally pliable supraglottic structures, which causes upper airway obstruction. In the past, different classification systems have been introduced. Until now no classification system is widely accepted and applied. Our goal is to provide a simple and complete classification system based on systematic literature search and our experiences.
  
  
  METHODS
  Retrospective cohort study with literature review.
  
  
  METHODS
  All patients with laryngomalacia under the age of 5 at time of diagnosis were included. Photo and video documentation was used to confirm diagnosis and characteristics of dynamic airway change. Outcome was compared with available classification systems in literature.
  
  
  RESULTS
  Eighty-five patients were included. In contrast to other classification systems, only three typical different dynamic changes have been identified in our series. Two existing classification systems covered 100% of our findings, but there was an unnecessary overlap between different types in most of the systems. Based on our finding, we propose a new a classification system for laryngomalacia, which is purely based on dynamic airway changes.
  
  
  CONCLUSIONS
  The groningen laryngomalacia classification is a new, simplified classification system with three types, based on purely dynamic laryngeal changes, tested in a tertiary referral center: Type 1: inward collapse of arytenoids cartilages, Type 2: medial displacement of aryepiglottic folds, and Type 3: posterocaudal displacement of epiglottis against the posterior pharyngeal wall.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Martijn
authors.initials: M
authors.lastname: van der Heijden
authors.forename: Frederik G
authors.initials: FG
authors.lastname: Dikkers
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Gyorgy B
authors.initials: GB
authors.lastname: Halmos
mesh_terms: D001193:Arytenoid Cartilage / Q000473:pathology; D002675:Child, Preschool; D015331:Cohort Studies; D004724:Endoscopy; D004825:Epiglottis / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D055092:Laryngomalacia / Q000145:classification* / Q000473:pathology; D008297:Male; D010614:Pharynx / Q000473:pathology; D012189:Retrospective Studies
keywords: classification; dynamic airway changes; laryngomalacia