Therapeutic evaluation of modified supraglottoplasty for laryngomalacia

Abstract

Objective:To evaluate the therapeutic effect of modified supraglottoplasty for laryngeal malacia in children. Method: All 22 children with laryngomalacia underwent modified supraglottoplasty were retrospectively analyzed. Surgical correction of type Ⅰ involved the ablation of redundant mucosal tissue over the arytenoids, keep the part below anesthetic intubation. Type Ⅱ was treated by ablation of the shortened aryepiglottic folds and/or ablation of the lateral edge of the epiglottis, separate the epiglottis with epiglottis to enlarge the laryngeal inlet. Type Ⅲ was corrected by ablating wound surfaces on the base of the tongue and epiglottic vallecula but no more than 1/2 area of lingual surface of epiglottis. All patients were kept intubated for 5 days after surgery in the intensive care unit （ICU）. Evaluate the severity of laryngomalacia before and after surgery （extubation）, 1 month after surgery, and 6 months after surgery. Visual analogue scale （VAS） was used to score the symptoms, including stridor, reflux or feeding difficulties, aspiration, dyspnea and frequency or severity of pneumonia. Clinical score was determined by the physician on the child's laryngeal obstruction, supraglottic morphology in laryngoscope, swallowing function, weight and the result of polysomnography. Result:All 22 children with laryngomalacia were followed up for 6 months after surgery, statistically significant differences in scores before, after, 1 month after and 6 months after surgery （P<0.01）. The symptoms of stridor, dyspnea and feeding difficulties were improved in different degrees. Conclusion:Modified supraglottoplasty for children with laryngomalacia simplified the surgical procedure, and the therapeutic effect is safe and reliable. The evaluation system designed in this study is more intuitive and objective to evaluate the severity of laryngomalacia and the operative effect, which may has certain reference value for the evaluation of the condition and the treatment process.