Epiglottopexy with or without aryepiglottic fold division: Comparing outcomes in the treatment of pediatric obstructive sleep apnea.

Background: Laryngomalacia is an abnormality of the larynx that leads to the inward collapse of the supraglottic structure during inspiration. The condition is primarily characterized by congenital stridor in infants and children. Diagnosis is often made based on the larynx visualization during inspiration. Laryngomalacia is generally recovers spontaneously at the age 2-5 years old, surgery is reserved for severe cases. Purpose: To obtain data of the clinical appearance, diagnosis, and therapy of laryngomalacia. Method: An observational study on medical records of all laryngomalacia patients at the Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine Universitas Airlangga /Dr. Soetomo General Hospital, Surabaya from January 1st, 2017 to December 31st, 2018. Data evaluation included clinical symptoms, type of laryngomalacia, comorbid factors, the age range of clinical improvement, and the management. Result: The main complaint of laryngomalacia was inspiratory stridor in 63 patients (82.89%), followed by dyspnea, snoring, hoarseness, and choking. Endoscopy finding mostly was type 1 in 69 patients (90.79%), the others were type 2 and 3. Comorbid factor mostly was neurological disease in 16 patients (21.03%), followed by congenital heart disease, congenital abnormality, prematurity, and laryngopharyngeal reflux. The age group of clinical improvement majority were 12-24 months, and no improvement in 56 patients (73.69%). Conservative therapy was conducted in 73 patients (96.05%) and 3 patients were tracheotomized. Conclusion: The main complaint of laryngomalacia was inspiratory noises, mostly found was laryngomalacia type 1.The highest comorbid factor was neurological disease. The most common management was conservative therapy. ABSTRAK Latar belakang: Laringomalasia adalah kolapsnya struktur supraglotik laring saat inspirasi. Laringomalasia umumnya sembuh spontan pada umur 2-5 tahun, pembedahan hanya dilakukan pada kasus yang berat. Tujuan: Memperoleh gambaran klinis penderita laringomalasia, diagnosis dan terapi. Metode: Penelitian observasional pada semua rekam medik yang lengkap penderita laringomalasia  di Departemen THT-KL RSUD Dr. Soetomo, Surabaya, periode 1 Januari 2017 - 31 Desember 2018. Data yang dievaluasi meliputi gejala klinik, tipe, faktor komorbid, usia perbaikan gejala, dan terapi. Hasil: Keluhan utama adalah napas berbunyi pada 63 penderita (82,89%), disusul sesak napas, mengorok saat tidur, suara parau, dan mudah tersedak. Temuan  endoskopik mayoritas tipe 1 pada  69 penderita (90,79%), sisanya tipe 2 dan 3. Faktor komorbid terbanyak penyakit neurologis pada   16 penderita (21,03%), disusul kelainan jantung bawaan, anomali kongenital, prematur, dan refluks laring faring. Usia perbaikan klinis mayoritas 12-24 bulan dan belum membaik 56 penderita (73,69%). Terapi konservatif dilakukan pada 73 penderita (96,05%) dan 3 penderita menjalani trakeotomi. Kesimpulan: Keluhan utama napas berbunyi, mayoritas laringomalasia tipe 1. Faktor komorbid terbanyak penyakit neurologis. Laringomalasia mayoritas diterapi secara konservatif.

http://www.orli.or.id/index.php/orli/article/download/405/242

Laryngomalacia: diagnosis and management at Otorhinolaryngology Head and Neck Surgery Department Dr.Soetomo Hospital, Surabaya

The prevalence of obstructive sleep apnea-hypopnea syndrome in the general childhood population is 1-2% and the most common cause is adenotonsillar hypertrophy. However, beyond adenotonsillar hypertrophy, there are other highly prevalent causes of this syndrome in children. The causes are often multifactorial and include muscular hypotonia, dentofacial abnormalities, soft tissue hypertrophy of the airway, and neurological disorders). Collaboration between different specialties involved in the care of these children is essential, given the wide variability of conditions and how frequently different factors are involved in their genesis, as well as the different treatments to be applied. We carried out a wide literature review of other causes of obstructive sleep apnea-hypopnea syndrome in children, beyond adenotonsillar hypertrophy. We organised the prevalence of this syndrome in each pathology and the reasons that cause it, as well as their interactions and management, in a consistent manner.

Obstructive Sleep Apnea-Hypopnea Syndrome in Children: Beyond Adenotonsillar Hypertrophy

Asthma is a chronic inflammatory disorder of the airways which is characterized by recurrent episodes of airway
obstruction, associated with airway hyper responsiveness that leads to symptoms of dyspnea, wheezing, chest
tightness, and/or coughing. Omega shaped epiglottis is a type of laryngomalacia which is a result of curling on itself
of the epiglottis because of shortened aryepiglottic folds.

/pdf/effort-dyspnea-if-it-is-not-asthma-an-omega-epiglottis-case-dgglcilk3h.pdf

Effort Dyspnea, if it is not Asthma? An Omega Epiglottis Case Report

Supraglottoplasty in the management of laryngomalacia in children with down syndrome: A systematic review.

Laryngomalacia is the most frequent congenital abnormality of the larynx, accounting for approximately 60-75% of congenital stridor cases. Despite its benign and self-limited aspects, 10% of cases require intervention. Currently, supraglottoplasty is considered the standard treatment of severe laryngomalacia.

Original ArticleSurgical treatment of severe laryngomalacia: a retrospective study of 11 cases

A laringomalacia e a anomalia congenita da laringe mais frequente, sendo responsavel por cerca de 60% a 75% dos casos de estridor congenito. Apesar de seu curso benigno e autolimitado, 10% dos casos necessitam de intervencao. Atualmente, as supraglotoplastias sao consideradas o tratamento padrao da laringomalacia grave. OBJETIVO: Descrever a experiencia adquirida pelos autores no tratamento cirurgico dos pacientes com laringomalacia grave. Metodologia: Estudo retrospectivo. METODO: Os prontuarios de 11 casos consecutivos de laringomalacia grave, submetidos ao tratamento cirurgico entre 2003 e 2012, foram analisados quanto a idade, genero, sintomas, doencas associadas, tecnica cirurgica adotada, tempo de extubacao, complicacoes cirurgicas, tempo de internacao e evolucao clinica. RESULTADOS: Dos 11 casos de laringomalacia grave, seis pacientes (54,5%) foram operados com o uso do laser de CO2 e em cinco pacientes (45,5%) foram realizadas a tecnica a frio. Apenas um paciente (9,1%) necessitou reabordagem cirurgica. Nao foram observados casos de complicacoes cirurgicas. Todos os pacientes apresentaram melhora clinica importante. CONCLUSAO: A supraglotoplastia mostrou-se um procedimento eficaz e seguro no tratamento da laringomalacia grave.

/pdf/tratamento-cirurgico-da-laringomalacia-grave-estudo-3strqg2xhc.pdf

Tratamento cirúrgico da laringomalácia grave: estudo retrospectivo de 11 casos

Laryngeal pathologies as an etiologic factor of obstructive sleep apnea syndrome in children.

Objective: 1) Be able to determine the effects of multiple surgeries in the treatment of moderate and severe obstructive sleep apnea. 2) Confirm the importance of identifying the sites of obstruction in the treatment of obstructive sleep apnea.Method: A retrospective review of a prospective dataset of 40 patients with moderate and severe obstructive sleep apnea who had undergone multiple surgeries. Patients studied underwent palatal surgery with or without nasal and tongue base surgery. Charts between 1997 and 2011 were reviewed and the surgical results were determined.Results: Thirty-two patients (80%) underwent UPPP, associated with midline glossectomy in 26 patients (65%). Five patients (12.5%) underwent expansion sphincter pharyngoplasty, associated with midline glossectomy in 1 patient (2.5%). One patient (2.5%) underwent lateral pharyngoplasty. At least some improvement occurred in 4 patients (40%) in the moderate OSAS group (n = 10), but 4 patients (40%) in this group showed a slight (nonsignifican...

/pdf/treatment-of-obstructive-sleep-apnea-with-multiple-surgeries-f7konckao6.pdf

Treatment of Obstructive Sleep Apnea with Multiple Surgeries

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Original ArticleSurgical treatment of severe laryngomalacia: a retrospective study of 11 cases

Tratamento cirúrgico da laringomalácia grave: estudo retrospectivo de 11 casos

Laryngeal pathologies as an etiologic factor of obstructive sleep apnea syndrome in children.

Treatment of Obstructive Sleep Apnea with Multiple Surgeries