Classification and Management in Patients with Laryngomalacia

후두연하증의 분류와 치료

  • Park, Gi Cheol (Department of Otolaryngology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine,)
  • 박기철 (성균관대학교 의과대학 삼성창원병원 이비인후과학교실)
  • Received : 2017.05.01
  • Accepted : 2017.06.02
  • Published : 2017.06.30

Abstract

Laryngomalacia is the most common congenital anomaly that causes inspiratory stridor and airway obstruction in the newborn. Symptoms begin to appear after weeks of age, become worse at 4-8 months, improve between 8-12 months, and usually heal naturally at 12-18 months. Despite these common natural processes, the symptoms of the disease can be very diverse and, in severe cases, require surgical treatment. The diagnosis can be made by suspicion of clinical symptoms and direct observation of the larynx with the spontaneous breathing of the child. Typical laryngeal features include omega-shaped epiglottis, retroflexed epiglottis, short aryepiglottic fold, poor visualization of the vocal folds, and edema of the posterior glottis, including inspiratory supra-arytenoid tissue prolapse. In this review, we discuss the classification and treatment based on symptoms and laryngoscopic findings in patients with laryngomalacia.

Keywords

References

  1. Cotton RT, Reilly JS. Congenital malformations of the larynx. Pediatric Otolaryngology. Vol 2. Philadelphia: WB Saunders;1983:1300-01.
  2. Zalzal GH, Anon JB, Cotton RT. Epiglottoplasty for the treatment of laryngomalacia. Ann Otol Rhinol Laryngol 1987;96(1):72-6. https://doi.org/10.1177/000348948709600118
  3. Seid AB, Park SM, Kearns MJ, Gugenheim S. Laser division of the aryepiglottic folds for severe laryngomalacia. Int J Pediatr Otorhinolaryngol 1985;10(2):153-8. https://doi.org/10.1016/S0165-5876(85)80027-6
  4. Lane RW,Weider DJ, Steinem C, Marin-Padilla M. A review and case report of surgical treatment with resolution of pectus excavatum. Arch Otolaryngol 1984;110(8):546-51. https://doi.org/10.1001/archotol.1984.00800340058017
  5. Thompson JM, Turner AL. On the causation of the congenital stridor in infants. BMJ 1900;2(2083):1561-3.
  6. Belmont JR, Graupdfast K. Congenital laryngeal stridor (laryngomalacia): Etiologic factors and associated disorders. Ann Otol Laryngol 1984;93(5):430-7. https://doi.org/10.1177/000348948409300502
  7. Ferguson CF. Congenital abnormalities of the infant larynx. Otolaryngol Clin North Am 1970;3(2):185-200.
  8. Archer SM. Acquired flaccid larynx: A case report supporting the neuro logic theory of laryngomalacia. Arch Otolaryngol Head Neck Surg 1992;118(6):654-7. https://doi.org/10.1001/archotol.1992.01880060104021
  9. Thompson DM. Abnormal sensorimotor integrative function of the larynx in congenital laryngomalacia: a new theory of etiology. Laryngoscope 2007;117(6 Pt 2, Suppl 114):1-33.
  10. Munson PD, Saad AG, El-Jamal S, Dai Y, Bower CM, Richter GT. Submucosal nerve hypertrophy in laryngomalacia: histopathological evidence. Laryngoscope 2011;121(3):627-9. https://doi.org/10.1002/lary.21360
  11. Lima TMA, Goncalves DU, Goncalves LV, Reis PA, Lana AB, Guimaraes FF. Flexible nasolaryngoscopy accuracy in laryngomalacia diagnosis. Rev Bras Otorrinolaringol (Engl Ed) 2008;74(1):29-32. https://doi.org/10.1590/S0034-72992008000100005
  12. Kay DJ, Goldsmith AJ. Laryngomalacia: a classification system and surgical treatment strategy. Ear Nose Throat J 2006;85(5):328-31,336.
  13. Olney DR, Greinwald JH Jr, Smith RJ, Bauman NM. Laryngomalacia and its treatment. Laryngoscope 1999;109(11):1770-5. https://doi.org/10.1097/00005537-199911000-00009
  14. Solomons NB, Prescott CA. Laryngomalacia: a review and the surgical management for severe cases. Int J Pediatr Otorhinolaryngol 1987;13(1):31-9. https://doi.org/10.1016/0165-5876(87)90005-X
  15. McSwiney PF, Cavanagh NP, Languth P. Outcome in congenital stridor (laryngomalacia). Arch Dis Child 1977;52(3):215-8. https://doi.org/10.1136/adc.52.3.215
  16. Holinger LD, Konior RJ. Surgical management of severe laryngomalacia. Laryngoscope 1989;99(2):136-42.
  17. Roger G, Denoyelle F, Triglia JM, Garabedian EN. Severe laryngomalacia: surgical indications and results in 115 patients. Laryngoscope 1995;105(10):1111-7. https://doi.org/10.1288/00005537-199510000-00018
  18. Kay DJ, Goldsmith AJ. Laryngomalacia: a classification system and surgical treatment strategy. Ear Nose Throat J 2006;85(5):328-31,336. https://doi.org/10.1177/014556130608500514
  19. Lee KS, Chen BN, Yang CC, Chen YC. CO2 laser supraglottoplasty for severe laryngomalacia: a study of symptomatic improvement. Int J Pediatr Otorhinolaryngol 2007;71(6):889-95. https://doi.org/10.1016/j.ijporl.2007.02.010
  20. Thevasagayam M, Rodger K, Cave D, Witmans M, El-Hakim H. Prevalence of laryngomalacia in children presenting with sleep-disordered breathing. Laryngoscope 2010;120(8):1662-6. https://doi.org/10.1002/lary.21025
  21. Richter GT, Rutter MJ, deAlarcon A, Orvidas LJ, Thompson DM. Late-onset laryngomalacia: a variant of disease. Arch Otolaryngol Head Neck Surg 2008;134(1):75-80. https://doi.org/10.1001/archoto.2007.17
  22. Giannoni C, Sulek M, Friedman EM, Duncan NO 3rd. Gastroesophageal reflux association with laryngomalacia: a prospective study. Int J Pediatr Otorhinolaryngol 1998;43(1):11-20. https://doi.org/10.1016/S0165-5876(97)00151-1
  23. Richter GT, Thompson DM. The surgical management of laryngomalacia. Otolaryngol Clin North Am 2008;41(5):837-64. https://doi.org/10.1016/j.otc.2008.04.011
  24. Groblewski JC, Shah RK, Zalzal GH. Microdebrider-assisted supraglottoplasty for laryngomalacia. Ann Otol Rhinol Laryngol 2009;118 (8):592-7. https://doi.org/10.1177/000348940911800811