Epiglottoplasty for the Treatment of Laryngomalacia

TLDR

Laryngomalacia is the most common congenital laryngeal anomaly, causing stridor and feeding difficulties that usually resolve by 18 months, but severe cases can lead to cardiopulmonary complications. The authors introduce epiglottoplasty, an endoscopic procedure that excises redundant mucosa from the epiglottis and adjacent structures to treat severe laryngomalacia. Epiglottoplasty is performed endoscopically, removing excess mucosa from the lateral epiglottis, aryepiglottic folds, arytenoids, and corniculate cartilages, with indications, techniques, postoperative care, and potential complications outlined. In ten patients, epiglottoplasty yielded good outcomes and provides a viable alternative to tracheotomy for severe laryngomalacia.

Abstract

Laryngomalacia is the most common congenital laryngeal anomaly. Patients present with different degrees of stridor and feeding problems that usually resolve by 18 months of age. A small number present with severe feeding problems, failure to thrive, stridor with cyanosis, and apnea, which may result in cardiopulmonary disease. These infants require surgical intervention, usually a hyomandibulopexy or tracheotomy. We present a new procedure, epiglottoplasty, that is performed endoscopically and involves excision of redundant mucosa over the lateral edges of the epiglottis, aryepiglottic folds, arytenoids, and corniculate cartilages. Ten patients have undergone this procedure with good results. Epiglottoplasty represents an alternative to tracheotomy in severe laryngomalacia. Indications, techniques, postoperative management, and complications are presented.