title: Supraglottoplasty in Infants: A Staged Approach.
abstract: OBJECTIVE
  While generally well tolerated for the treatment of severe laryngomalacia, bilateral supraglottoplasty has potential complications including supraglottic stenosis and aspiration. We report a more conservative staged supraglottoplasty in infants with severe laryngomalacia.
  
  
  METHODS
  A retrospective review was performed of our patients who underwent staged supraglottoplasty from June 2007 to June 2012. Fifteen infants were identified and scored based on stridor, retractions, oxygen saturation, and feeding quality. Outcomes were compared with those reported in the literature for conventional bilateral supraglottoplasty.
  
  
  RESULTS
  Seventy-three percent had significant improvement or resolution of stridor following the first stage of surgery and 100% in those undergoing a second stage. Twelve patients (80%) had mild to no retractions following one procedure and 100% had resolution after a second surgery. All 6 patients with recurrent preoperative desaturations had resolution after the first stage of surgery. Of the 11 infants who had preoperative moderate-severe feeding problems, 9 of them (82%) had resolution after one surgery and the remaining 2 had resolution after a second surgery. There were no complications in any of the patients.
  
  
  CONCLUSIONS
  Staged supraglottoplasty appears to be an effective, low-risk method to treat severe laryngomalacia. A second procedure was only required in 40% of patients.
authors.affiliation: Department of Otolaryngology, Rush University Medical Center, Chicago, IL, USA Department of Surgery, Pediatric Otolaryngology, Pediatric Airway Center, Advocate Children's Hospital, Park Ridge, IL, USA dwalner@comcast.net.
authors.forename: David L
authors.initials: DL
authors.lastname: Walner
authors.affiliation: School of Medicine, Rush Medical College, Chicago, IL, USA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Neumann
authors.affiliation: Department of Otolaryngology, Rush University Medical Center, Chicago, IL, USA Department of Surgery, Pediatric Otolaryngology, Pediatric Airway Center, Advocate Children's Hospital, Park Ridge, IL, USA.
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Hamming
authors.affiliation: Department of Surgery, Pediatric Otolaryngology, Pediatric Airway Center, Advocate Children's Hospital, Park Ridge, IL, USA.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Miller
mesh_terms: D004825:Epiglottis / Q000473:pathology / Q000601:surgery; D005248:Feeding Methods; D005260:Female; D005931:Glottis / Q000473:pathology / Q000601:surgery; D006801:Humans; D007223:Infant; D055092:Laryngomalacia / Q000150:complications / Q000151:congenital / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery; D058753:Laryngoplasty / Q000009:adverse effects / Q000379:methods; D008297:Male; D010101:Oxygen Consumption; D011184:Postoperative Period; D012135:Respiratory Sounds / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: airway disorders; larynx; outcomes; reconstructive techniques; surgical management