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    Surgical Treatment of Severe Laryngomalacia

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    Putri Hakim
    1) The study evaluated 11 cases of severe laryngomalacia that underwent surgical treatment. Bilateral aryepiglottoplasty was the most common procedure. 2) Results found that all patients had progressive symptom improvement after surgery. The majority were extubated within 48 hours and had hospital stays under 35 days. 3) Complications of supraglottoplasty include bleeding, edema, infection, dysphagia, and stenosis. The use of CO2 laser can decrease risks. 4) The study concludes that supraglottoplasty is an effective procedure for treating respiratory obstruction in severe laryngomalacia cases, with high resolution rates and less surgical risk compared

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    Surgical Treatment of Severe Laryngomalacia

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    Putri Hakim
    28 views7 pages
    1) The study evaluated 11 cases of severe laryngomalacia that underwent surgical treatment. Bilateral aryepiglottoplasty was the most common procedure. 2) Results found that all patients had progressive symptom improvement after surgery. The majority were extubated within 48 hours and had hospital stays under 35 days. 3) Complications of supraglottoplasty include bleeding, edema, infection, dysphagia, and stenosis. The use of CO2 laser can decrease risks. 4) The study concludes that supraglottoplasty is an effective procedure for treating respiratory obstruction in severe laryngomalacia cases, with high resolution rates and less surgical risk compared

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    1) The study evaluated 11 cases of severe laryngomalacia that underwent surgical treatment. Bilateral aryepiglottoplasty was the most common procedure. 2) Results found that all patients had progressive symptom improvement after surgery. The majority were extubated within 48 hours and had hospital stays under 35 days. 3) Complications of supraglottoplasty include bleeding, edema, infection, dysphagia, and stenosis. The use of CO2 laser can decrease risks. 4) The study concludes that supraglottoplasty is an effective procedure for treating respiratory obstruction in severe laryngomalacia cases, with high resolution rates and less surgical risk compared

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    28 views7 pages

    Surgical Treatment of Severe Laryngomalacia

    Uploaded by

    Putri Hakim
    1) The study evaluated 11 cases of severe laryngomalacia that underwent surgical treatment. Bilateral aryepiglottoplasty was the most common procedure. 2) Results found that all patients had progressive symptom improvement after surgery. The majority were extubated within 48 hours and had hospital stays under 35 days. 3) Complications of supraglottoplasty include bleeding, edema, infection, dysphagia, and stenosis. The use of CO2 laser can decrease risks. 4) The study concludes that supraglottoplasty is an effective procedure for treating respiratory obstruction in severe laryngomalacia cases, with high resolution rates and less surgical risk compared

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    of 7

    Surgical treatment of severe laryngomalacia:

    a huhu
    retrospective study of 11 case
    galau ni, tapi w tetep sore aja de, pagi nya mau pergi dulu
    karnaa, maafin ya jaa

    José Antonio Pinto, Henrique Wambier, Elcio Izumi Mizoguchi, Leonardo Marques


    Gomes, Rodrigo Kohler, Renata Coutinho Ribeiro

    Presented by Fateha Putri Hakim, MD


    Jakarta, November 27th 2020
    BACKGROUND  Affecting 60-75% of congenital stridor case
     Typically begin at age 2 weeks, with
    incidence peak around 6 months
    LARYNGOMALACIA  10% cases require intervention ~ severe
    laryngomalacia

    Aryepiglottoplasty
    Pathogenesis is uknown, Intervention Arytenoidoplasty
    - Tracheotomy
     Exacerbated in the supine position - Hyomandibulopexy Epiglottoplasty
    during feeding, agitation and crying - Supraglottoplasties Epiglottoplexy
     A collapse of supraglottic tissues Epiglottectony
    during inspirations  producing
    inspiratory stridor

    AIMS: Describe and evaluatevcases in the surgical treatment


    of patients with severe laryngomalacia
    METHODS
    • Longitudinal historical Cohort Study
    • Pediatric ICU – Tertiary Hospital

    January 2003 April 2012


    Inclusion Exclusion
    Patient with severe laryngomalacia who Patient with severe laryngomalacia who not take
    underwent surgical treatment surgical treatment

    Age Gender
    Hospital Stay

    Variables Evaluated Symptomps Assosiated disorders


    Clinical Outcome
    Surgery Extubation time
    RESULTS
    Cases Age Gender Symptomps Associated diseases Surgical Treatment Extubation Hospital Clinical Outcome
    Stay
    1 3 M Stridor, dypsnea, Hypoxic Bilateral 48H 34 days Progressive symptom
    Months cyanosis encephalopathy, aryepiglottoplasty improvement
    bronchopulmonary & CO2 laser
    dysplasia, renal failure Vaporization of the
    lingual face of the
    epiglottis
    2 2 M Stridor, dypsnea, None Bilateral Immediate post 1 day Progressive symptom
    Months cyanosis aryepiglottoplasty op improvement
    & CO2 laser
    3 3 F Stridor, furcula Hypoxic Bilateral 48H 7 days Progressive symptom
    Months retraction, dyspnea, encephalopathy, aryepiglottoplasty improvement
    cyanosis ischemic hypoxia & CO2 laser
    4 1 M Cyanosis, apnea, insuff. GERD -Cold bilateral 48H 35 days Progressive symptom
    Months weight gain aryepiglottoplasty + improvement
    aryepiglottoplasty and
    removal of the
    redundant arytenoid
    mucosa with the CO2
    laser

    5 2 M Dyspnea, Bronchospasm None -Cold bilateral Immediate post 100 Need for
    Months aryepiglottoplasty op. Reintubation days reintervention and
    -Bilateral after 3 days for Progressive symptom
    aryepiglottoplasty resp. distress improvement
    & CO2 laser
    6 2 M Stridor, furcula & Down Syndrome, Cold bilateral Immediate post 20 days Progressive symptom
    Months intercostal Retraction GERD aryepiglottoplasty op improvement
    7 4 M Dysphagia, Stridor, Interatrial Cold bilateral 48H 31 days Progressive symptom
    Months furcula intercostal communication aryepiglottoplasty improvement
    Discussion (1) Indication surgical treatment:
     Development delays
     Feeding issues
    Laryngomalacia  Severe gastroesophageal reflux
     Predominance among male patients.  Airway obstruction symptomps
     The inspiratory stridor is the most
    important & frequent symptom

    Unilateral supraglottoplasty [Kelly Gray]: Bilateral aryepiglottoplasty [Loke et al]:


    -successful surgery in 94% of cases w/o -Complete resolution of stridor in 68.7% of
    major complications (involving 18 patiens) cases (involving 33 patiens)
    -In 16.67% of cases required a bilateral -Partial resolution in seven (21.8%)
    aryepiglottic fold approach -Reoperation surgery in two patients
    -One patient with multiple malformations
    underwent tracheostomy

     Bilateral aryepiglottoplasty as the procedure of choice at author institution


     The epi-glottoplasty and arytenoidoplasty are kept as a complementary
    method to aryepiglottoplasty, to improve the supraglottic obstruction.
    Complications of supraglottoplasty:
    Discussion (2) • Bleeding • Dysphagia
    • Edema • Supraglottic
    • Infection stenosis
    Excessive removal of laryngeal tissues • Aspiration • Synechia
    rather than bilateral aryepiglotoplasty • Respiratory
    failure and
    death
    The use of CO2 laser:
    The different compare to previous study: -decrease risk of intraoperative bleeding
    - Less patient presents transient aspiration and postoperative edema in cases of
    - Patients in ICU for a min. 24 hours greater mucosal resection, as in
    - Diagnosis based on clinical and nasal- epiglottoplasty and arytenoidoplasty
    laryngoscopy findings --- no cases of synchronous
    lesions happen in patients

     The diagnosis of laryngomalacia is being restricted to the tertiary level of care


     The success rate of supraglottoplasty is about 38-100%
     The clinical improvement of all patients submitted to surgical treatment reach 100% of
    cases
    CONCLUSION
    • Supraglottoplasty  an effective procedure in the treatment of respiratory
    obstruction, which enlarging the laryngeal lumen.
     Its has high resolution, and less surgical complication.
     a safe procedure in the treatment of children with severe
    laryngomalacia

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