Supraglottoplasty in Infants Using Sinus Instruments

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

November 26, 2008

Case Report

A 2-month-old male child, born at term by vaginal delivery, was referred to Johns Hopkins Pediatric Otolaryngology with progressive airway obstruction and inspiratory stridor first noted at 4 days of age. At evaluation, he was a well-nourished 5-kg infant with inspiratory high-pitched stridor, marked inspiratory sternal retraction, and a normal cry. Prolonged feeding time was noted in the clinic. Fiberoptic optic laryngoscopy showed inspiratory supraglottic obstruction from constricted aryepiglottic folds and anteromedial curling of the supra-arytenoid mucosa.

He was admitted to the Johns Hopkins Children's Center with increased work of breathing. He underwent supraglottoplasty by conservative excision of a small wedge of aryepiglottic fold on each side (Figures 2a-c). He was extubated shortly after surgery and was discharged after 24 hours of monitored observation with no stridor. He continues to do well without symptoms at 22 months of age.

References

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Cite this: Supraglottoplasty in Infants Using Sinus Instruments - Medscape - Nov 26, 2008.

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

Case Report

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References

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