Supraglottoplasty in Infants Using Sinus Instruments

Introduction

Laryngomalacia is the most common cause of stridor in neonates. Holinger found laryngomalacia in 60% of children with congenital laryngeal anomalies who presented with stridor.^[1] Most children with laryngomalacia resolve within 18 to 24 months of birth and require no specific treatment. Quality-of-life analysis has found that most caregivers were not substantially affected by providing care to the child with laryngomalacia.^[2]

However, children with severe laryngomalacia may develop marked upper airway obstruction resulting in cor pulmonale, life-threatening apneic episodes, feeding difficulties, obstructive sleep apnea, and failure to thrive.^[3] While tracheotomy has been used in complex neonates in whom laryngomalacia is associated with other anomalies or medical problems, surgical resection of supraglottic tissues -- "supraglottoplasty" -- has been the favored approach.

We describe a simple, safe, and effective method of supraglottoplasty, first used by the senior author (DET), using through-cutting sinus dissection forceps (Figure 1) to incise or resect a portion of the aryepiglottic fold.

(Enlarge Image)

Figure 1.

Straight through-cutting sinus forceps and Parsons laryngoscope used for supraglottoplasty.

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Table. Supraglottoplasty Using Sinus Instruments
ADVANTAGES	DISADVANTAGES
Ideal instrument length	Not helpful for posterior epiglottic displacement
Precise excision with reduced tissue trauma	Need adjunctive resection for redundant supra-arytenoid mucosa
Can be performed with/without endotracheal tube	Thick aryepiglottic folds may be hard to cut
Rapid operative time
Instruments available in every ENT OR
Avoid cumbersome equipment and setup time

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Supraglottoplasty in Infants Using Sinus Instruments

Introduction

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Authors and Disclosures

Authors and Disclosures

Figure 1.

Figure 1.

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