Synchronous airway lesions and outcomes in infants with severe laryngomalacia requiring supraglottoplasty

James W. Schroeder, Naveen D. Bhandarkar, Lauren D. Holinger

Research output: Contribution to journalArticlepeer-review

61 Scopus citations

Abstract

Objective: To quantify the prevalence and the impact of synchronous airway lesions identified by endoscopy in infants undergoing supraglottoplasty for severe laryngomalacia (LM). Design: Retrospective study. Setting: Tertiary care pediatric hospital. Patients: Sixty patients who underwent supraglottoplasty for severe LM from 2002 to 2006. Patients who underwent preoperative tracheotomy, had previous airway surgery, or did not have 6 months of follow-up were excluded. Fifty-two patients met inclusion criteria. Intervention: Supraglottoplasty (with carbon dioxide laser). Main Outcome Measures: Presence of synchronous airway lesions and their contribution to upper airway obstruction (UAO) and their effect on the postoperative course after supraglottoplasty. Results: Fifty-eight percent of patients had synchronous airway lesions (SALs), ofwhom77% had subglottic stenosis (SGS) and47%had tracheomalacia, bronchomalacia, or both. Sixty-three percent of all patients required postoperative nonsurgical airway support. Eight patientshadresidual UAO requiring additional surgical intervention, with 3 revision supraglottoplasties and 7 tracheotomies performed. Infants with neurological conditions had a high rate of surgical intervention(55%;P=.001). PatientswithSGSexceeding 35% but without any neurological condition had a prolonged hospital stay (<3.6 days; P=.02) and an 83% incidence (P=.04) of postoperative UAO requiring intubation. Infants withLMwith laryngeal edema (LE) alone had increased frequency of postoperative nonsurgical airway support (P=.02) and a prolonged hospital stay of 1 day (P=.01) compared with infants without edema. Conclusions: There is a high incidence of SALs in patients undergoing supraglottoplasty. Neurological conditions, hypoplastic mandible, SGS greater than 35%, and preexisting LE independently adversely affected the postoperative course.

Original languageEnglish (US)
Pages (from-to)647-651
Number of pages5
JournalArchives of Otolaryngology - Head and Neck Surgery
Volume135
Issue number7
DOIs
StatePublished - Jul 2009

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology

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