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James W. Schroeder Jr, MD; Naveen D. Bhandarkar, MD; Lauren D. Holinger, MD

Arch Otolaryngol Head Neck Surg. 2009;135(7):647-651.

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), of whom 77% had subglottic stenosis (SGS) and 47% had tracheomalacia, bronchomalacia, or both. Sixty-three percent of all patients required postoperative nonsurgical airway support. Eight patients had residual 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). Patients with SGS exceeding 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 with LM with 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.

Author Affiliations: Department of Surgery, Northwestern University Feinberg School of Medicine (Drs Schroeder and Holinger), Division of Pediatric Otolaryngology, Children's Memorial Hospital (Drs Schroeder and Holinger), and Department of Otolaryngology–Head and Neck Surgery, University of Illinois at Chicago (Dr Bhandarkar), Chicago.

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