Role of Radiofrequency Cautery in Laryngomalacia: a Study in 12 Patients

Abstract

Laryngomalacia is the most common condition causing inspiratory stridor at or shortly after birth accounting for approximately 60% of cases. Inspiratory stridor typically occurs after few days or week and is initially mild, but over a period of 6-9months it gets more pronounced. Spontaneous improvement usually occurs over a period of 18months to 2years. Although majority of cases of laryngomalacia have benign course without any long-term sequel. Typically symptoms are worse during sleep and supine position while the same improves in prone position. There are 12 cases in the present study with the average age of the baby was 4.74months (142days). Male to female ratio of 1:1. Those babies with life-threatening apnea, significant cyanotic (blue) spells, failure to thrive with feeding difficulty, significant chest wall and neck retractions with breathing and requires oxygen to breathe were included in the study. One patient presented with tracheostomy tube in place. Two babies were preterm. These preterm babies were initially kept on ventilator before the final diagnosis was made. The findings were different in all the cases. The common findings are cyclical collapse of supraglottic larynx with inspiration, short aryepiglottic folds, indrawing of cuneiform and corniculate cartilages forward over the laryngeal inlet resulting in prolapse during inspiration. The surgical procedures in laryngomalacia babies were combined according to the type of laryngomalacia. The procedures performed were supraglottoplasty (Unilateral/Bilateral), epiglottoplasty, aryepiglottoplasty, aryepiglottic fold division, epiglottopexy. The procedures were performed by radiofrequency cautery under general anesthesia. The average hospital stay in nine patients was less then 36h and more then 7days in remaining three patients. In tracheostomized patient second surgical procedure was done as after the first procedure failed to decannulate the child. The postoperative period was uneventful. The average follow up was 10months.