Aspiration following CO₂ laser-assisted supraglottoplasty

Objective: To review the incidence, risk factors, and treatment of aspiration following CO₂ laser-assisted supraglottoplasty for severe laryngomalacia (LM). Design: IRB approved retrospective study of pediatric patients with severe LM treated with CO₂ laser supraglottoplasty over a 5-year period. Setting: Tertiary pediatric hospital. Patients: Fifty-two patients met inclusion criteria. Indication for supraglottoplasty was respiratory distress in 90% of patients and/or failure to thrive in 19%. Interventions: All children underwent bilateral CO₂ laser supraglottoplasty and were assessed postoperatively with swallow evaluation by a speech pathologist. Videoflouroscopic evaluation was utilized to confirm aspiration and guide management. Main outcome measures: Aspiration, treatment required to manage aspiration, duration of treatment required. Results: Thirty-seven percent (20/52) of patients had postoperative aspiration. Aspiration was demonstrated on videoflouroscopic swallow study (VFSS) after supraglottoplasty is 28% (12/43). All patients with newly diagnosed aspiration had treatment with thickened and/or nasogastric feedings with mean resolution time of 6 months. In nine children with preoperative aspiration, eight (89%) had postoperative aspiration and seven required gastrostomy tube placement for feeding management. All individuals requiring gastrostomy for aspiration management had neurological conditions. In the absence of preoperative clinically evident aspiration, children with neurological conditions have an equivalent rate of postoperative aspiration as healthy children. The only risk factor for postoperative aspiration was preoperative aspiration. Conclusion: Aspiration is more common after CO₂ laser-assisted supraglottoplasty than previously recognized. In otherwise healthy children, postoperative aspiration is of short duration and can be treated with conservative measures. Optimal treatment after supraglottoplasty includes screening for and management of aspiration in conjunction with a speech pathologist.