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10 Years' Experience in the West of Scotland

Andrew D. Whymark, MBChB, AFRCS; W. Andrew Clement, MBChB, FRCS; Haytham Kubba, MPhil, FRCS(ORL-HNS); Neil K. Geddes, MBChB, FRCS, CertGAM

Arch Otolaryngol Head Neck Surg. 2006;132:978-982.

Objectives  To determine the results of laser epiglottopexy and to compare them with other surgical techniques for severe laryngomalacia.

Design  A retrospective 10-year case note review of laser epiglottopexy for severe laryngomalacia.

Setting  Royal Hospital for Sick Children, Glasgow, Scotland.

Patients  The study population comprised 52 male and 24 female children who underwent surgery for laryngomalacia between January 1, 1993, and December 31, 2002. In all children except 2, the indication for surgery was stridor associated with poor feeding and failure to thrive. The age at presentation ranged from 5 days to 32 months (mean, 16 weeks). Three had neurological problems, in 3 a syndrome was diagnosed, and 2 were described as dysmorphic and no syndrome was diagnosed; 5 had a cardiac abnormality. Complete follow-up data were available for 59 children (78%).

Intervention  Laser epiglottopexy.

Main Outcome Measure  Resolution of stridor and growth velocity.

Results  Resolution of stridor was complete in 34 children, with mild residual stridor in 4 and persistent stridor but good weight gain in 5 (73% improved sufficiently with 1 procedure). Improvement was documented objectively by measuring growth velocity. Two children required a brief period of intubation postoperatively, and 4 had postoperative respiratory tract infections. Seven children (12%) required revision endoscopic laser surgery to control symptoms. There were no cases of supraglottic stenosis. One child died of cardiac abnormalities, and 8 (14%) required a tracheostomy, of whom 6 had neurological or syndromal abnormalities and 2 had associated tracheomalacia.

Conclusions  We describe a technique of laser epiglottopexy for laryngomalacia and present objective evidence of its efficacy by means of growth velocity charts in a retrospective review of laryngomalacia surgery over a 10-year period. We believe this to be a safe method for treating a self-limiting condition. We have had comparable success to other surgical techniques without having the risks of permanent scarring to the supraglottis.

Author Affiliations: Department of Paediatric Otolaryngology Head and Neck Surgery, Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland.

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