title: Visualization of the Supraglottis in Laryngomalacia With 3-Dimensional Pediatric Endoscopy.
abstract: OBJECTIVE
  The use of 3-dimensional (3D) endoscopy has been described in the pediatric airway and has been shown to improve visualization of complex airway anatomy. Laryngomalacia is one of the most common airway disorders evaluated in pediatric otolaryngology offices. Whether 3D visualization is superior to standard endoscopy as a means for assessment and surgical management of complex airway anatomy is unclear.
  
  
  OBJECTIVE
  To describe a pilot case series using 3D endoscopy to facilitate supraglottoplasty and to assess surgical outcomes.
  
  
  METHODS
  A prospective case series was conducted of 11 children undergoing supraglottoplasty from July 1, 2010, to June 31, 2014, at a tertiary care pediatric hospital. Infants and children with symptomatic laryngomalacia were eligible for the study. Follow-up was completed on December 31, 2014, and data were assessed from February 1 to 15, 2015.
  
  
  METHODS
  Supraglottoplasty performed using 3D endoscopy.
  
  
  METHODS
  The outcome data collected included length of hospital stay and frequency of complications (ie, aspiration, granuloma formation, supraglottic narrowing, revision surgery, tracheostomy, and gastrostomy).
  
  
  RESULTS
  Eleven children were treated for laryngomalacia with supraglottoplasty (6 boys and 5 girls; mean [SD] age, 29 [85] months). Four of these children (36%) also had grade I subglottic stenosis. The 3D endoscope was judged by all participating senior surgeons to improve visualization of the supraglottic anatomy and to permit more precise tissue removal. No complications occurred after the surgery. Hospital stay was found to be an unreliable indicator owing to multiple comorbidities in many children. Worsening of aspiration occurred in 1 child (9%) who subsequently required gastrostomy tube placement. This child demonstrated progressive neurologic impairment and had severe hypotonia and developmental delay. Another child with subglottic stenosis and subglottic cysts required a tracheostomy owing to severe rhinovirus tracheitis. The remaining 9 children (82%) had good outcomes, with a mean follow-up of 14.7 (range, 12-24) months.
  
  
  CONCLUSIONS
  The anatomy of the supraglottis in laryngomalacia is better visualized using 3D techniques. Use of 3D endoscopy may allow for more precise tissue removal. The outcomes and complication rates are similar to those of standard 2D techniques. This study provides a platform to begin comparative analysis between 3D and standard 2D techniques.
authors.affiliation: Department of Otolaryngology, Naval Medical Center, San Diego, California2Division of Otolaryngology, Children's National Medical Center, Washington, DC.
authors.forename: Philip
authors.initials: P
authors.lastname: Gaudreau
authors.affiliation: Division of Otolaryngology, Baylor College of Medicine, San Antonio, Texas.
authors.forename: M Taylor
authors.initials: MT
authors.lastname: Fordham
authors.affiliation: currently a medical student at George Washington University School of Medicine, Washington, DC.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Dong
authors.affiliation: Division of Otolaryngology, Children's National Medical Center, Washington, DC.
authors.forename: Xinyang
authors.initials: X
authors.lastname: Liu
authors.affiliation: Division of Otolaryngology, Children's National Medical Center, Washington, DC.
authors.forename: Sukryool
authors.initials: S
authors.lastname: Kang
authors.affiliation: Division of Otolaryngology, Children's National Medical Center, Washington, DC.
authors.forename: Diego
authors.initials: D
authors.lastname: Preciado
authors.affiliation: Division of Otolaryngology, Children's National Medical Center, Washington, DC.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Reilly
mesh_terms: D002675:Child, Preschool; D004724:Endoscopy / Q000379:methods*; D004825:Epiglottis / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D055092:Laryngomalacia / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D058753:Laryngoplasty / Q000379:methods; D007829:Laryngostenosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D016896:Treatment Outcome