David E. Tunkel, MD; Karin S. Hotchkiss, MD; Stacey Ishman, MD; David Brown, MD


November 26, 2008

Method/Surgical Procedure

Infants were diagnosed with laryngomalacia by awake fiberoptic laryngoscopy performed in the office setting. Supraglottoplasty was recommended for the unusual infant with laryngomalacia who had increased work of breathing requiring hospitalization or had failure to thrive from feeding difficulties.

Supraglottoplasty was performed under general anesthesia at the time of endoscopy to exclude synchronous airway lesions. Infants were suspended with a Benjamin-Parsons laryngoscope, and the larynx was visualized with the operating microscope or a rigid telescope. The aryepiglottic folds were palpated with and without the presence of an endotracheal tube (Figure 2a). The area of constriction, usually just anterior to the cuneiform cartilage, was grasped with the straight through-cutting sinus forceps with a 3- to 4-mm jaw length (Medtronic-Xomed, Jacksonville, Florida; Boss Instruments, Nashville, Tennessee) (Figure 2b). The tissue was slowly compressed to facilitate hemostasis, until the cut was completed and tissue removed (Figure 2c). The incision usually extends to, but not inferior to, the level of the false vocal cord. A small wedge of tissue is removed to effectively lengthen the aryepiglottic fold. Wider or deeper incision/excision can be accomplished with additional applications of the through-cutting forceps. Pledgets of cocaine or oxymetazoline can be applied for hemostasis.

Figure 2a.

Laryngomalacia in patient 1, with aryepiglottic fold exposed with the Benjamin-Parsons suspension laryngoscope while intubated.

Figure 2b.

Right aryepiglottic fold being compressed and incised with the through-cutting forceps.

Figure 2c.

Both aryepiglottic folds have had wedge-resection supraglotttoplasty.


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