title: Surgical treatment of severe laryngomalacia: Six month follow up.
abstract: BACKGROUND
  Laryngomalacia (LM) is the most common congenital anomaly of larynx that causes stridor in children. We evaluated the efficacy of epiglottic suture and laser epiglottopexy for treatment of infants with severe LM.
  
  
  METHODS
  Surgical intervention was performed in 19 patients with severe LM, after the diagnosis was established using flexible laryngotracheobronchoscopy. Five patients had isolated type 1 LM, and 14 patients had a combination of type 1 and 3 LM. Indication for surgical treatment was the presence of LM with at least one of the following: malnutrition (body mass index [BMI] Z score < -2 SD), dysphagia or symptoms of gastroesophageal reflux and mean oxygen saturation (SaO2 ) <92% with oxygen desaturation index (ODI) > 3.
  
  
  RESULTS
  Epiglottic suture was performed in 11 patients, and laser epiglottopexy in eight, at mean age 3.95 ± 2.4 months. Rate of operation was 2.2-fold greater for more severe anomaly (combination of type 1 and 3 LM) than for isolated type 1. At 6 month follow up symptoms had gradually improved, as well as nutritional status, with increase of mean BMI Z score from -3.7 to -0.9 (P < 0.01). Mean preoperative SaO2 was 89.4 ± 4.3% with mean ODI of 5.8. At 6 month follow up, mean SaO2 was 96.7 ± 1.1%, and mean ODI was 1.2 (P < 0.01).
  
  
  CONCLUSIONS
  Epiglottic suture and laser epiglottopexy are efficient surgical techniques that lead to significant improvement of symptoms, oxygenation and nutritional status in patients with LM.
authors.affiliation: Department of Otorhinolaryngology, "Dr Vukan Cupic" Mother and Child Health Institute of Serbia, Belgrade, Serbia.
authors.forename: Ivan
authors.initials: I
authors.lastname: Baljosevic
authors.affiliation: Department of Pulmonology, "Dr Vukan Cupic" Mother and Child Health Institute of Serbia, Belgrade, Serbia.|School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Predrag
authors.initials: P
authors.lastname: Minic
authors.affiliation: School of Medicine, University of Belgrade, Belgrade, Serbia.|Institute for Medical Statistics, Belgrade, Serbia.
authors.forename: Goran
authors.initials: G
authors.lastname: Trajkovic
authors.affiliation: Clinic for Pediatrics, "Dr Vukan Cupic" Mother and Child Health Institute of Serbia, Belgrade, Serbia.
authors.forename: Gordana
authors.initials: G
authors.lastname: Markovic-Sovtic
authors.affiliation: Clinic for Pediatrics, "Dr Vukan Cupic" Mother and Child Health Institute of Serbia, Belgrade, Serbia.
authors.forename: Bojana
authors.initials: B
authors.lastname: Radojicic
authors.affiliation: Department of Pulmonology, "Dr Vukan Cupic" Mother and Child Health Institute of Serbia, Belgrade, Serbia.|School of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Sovtic
mesh_terms: D015992:Body Mass Index; D001999:Bronchoscopy / Q000379:methods*; D004825:Epiglottis / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D055092:Laryngomalacia / Q000175:diagnosis / Q000601:surgery*; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Epiglottopexy; laryngeal suture; laryngomalacia; stridor