Laser Supraglottoplasty Research Articles

Airway challenges in an infant undergoing laser supraglottoplasty for laryngomalacia.

Airway challenges in an infant undergoing laser supraglottoplasty for laryngomalacia.

Exercise-induced Laryngeal Obstruction: Protocol for a Randomized Controlled Treatment Trial.

BackgroundExercise-induced laryngeal obstruction (EILO) is a common cause of exertional breathing problems in young individuals, caused by paradoxical inspiratory adduction of laryngeal structures, and diagnosed by continuous visualization of the larynx during high-intensity exercise. Empirical data suggest that EILO consists of different subtypes, possibly requiring different therapeutic approaches. Currently applied treatments do not rest on randomized controlled trials, and international guidelines based on good evidence can therefore not be established. This study aims to provide evidence-based information on treatment schemes commonly applied in patients with EILO.Methods and AnalysisConsenting patients consecutively diagnosed with EILO at Haukeland University Hospital will be randomized into four non-invasive treatment arms, based on promising reports from non-randomized studies: (A) standardized information and breathing advice only (IBA), (B) IBA plus inspiratory muscle training, (C) IBA plus speech therapy, and (D) IBA plus inspiratory muscle training and speech therapy. Differential effects in predefined EILO subtypes will be addressed. Patients failing the non-invasive approach and otherwise qualifying for surgical treatment by current department policy will be considered for randomization into (E) standard or (F) minimally invasive laser supraglottoplasty or (G) no surgery. Power calculations are based on the main outcomes, laryngeal adduction during peak exercise, rated by a validated scoring system before and after the interventions.Ethics and DisseminationThe study will assess approaches to EILO treatments that despite widespread use, are insufficiently tested in structured, verifiable, randomized, controlled studies, and is therefore considered ethically sound. The study will provide knowledge listed as a priority in a recent statement issued by the European Respiratory Society, requested by clinicians and researchers engaged in this area, and relevant to 5–7% of young people. Dissemination will occur in peer-reviewed journals, at relevant media platforms and conferences, and by engaging with patient organizations and the healthcare bureaucracy.

Long term Follow Up of Severe Laryngomalacia Patients Following CO2 LASER Supraglottoplasty.

Laryngomalacia is the most common cause of stridor. It is believed to be due to delayed development of the supraglottic structures. On the basis of presentation, it has been divided into 3 grades. Management is dependent upon the grades: Mild and moderate laryngomalacia are managed conservatively, while CO2 LASER supraglottoplasty is the surgical management of choice for severe disease. In this study we evaluated the outcomes of supraglottopasty in long term follow up. It was a retrospective study which included patients with severe laryngomalacia who have undergone supraglottoplasty for the dates from July 2013 to July 2018. Weight and height of the patients were taken during the follow up visit after one year and have been compared with that of the normal children of comparable age using the pediatrics growth charts. Follow up was done by telephonic conversation to evaluate the status of other symptoms associated with laryngomalacia. Total of 44 patients were included in the study, 47.7% and 52.3% females and males respectively. Weight for age, weight for height and height for age were normal in 80.9%, 80.9% and 76.1% of patients respectively after supraglottoplasty. Of the patients studied, stridor was resolved in 80.9%, early tiredness during play was resolved in 43.2%, swallowing was normal in 85.7% and there was no aspiration in 90.5%. It can be concluded that patients with severe laryngomalacia improved with respect to airway symptoms, as well as, weight and height on long term follow up after CO2 LASER supraglottoplasty. It is important to evaluate the general status of the patients as a whole to truly assess the success of the surgery in addition to the airway symptoms.

172 Takotsubo Cardiomyopathy Mimicking ST-Elevation Myocardial Infarction Secondary to Nebulised Adrenaline for Upper Airway Obstruction

Takotsubo cardiomyopathy has a strong association with catecholamines. However, the occurrence of this in the context of nebulised adrenaline is not well reported. We are presenting a case of a 64-year-old man with cardiogenic shock secondary to Takotsubo cardiomyopathy in the context of nebulised adrenaline administered for upper airway obstruction. Originally presenting with a threatened airway: stridor, shortness of breath and dysphonia, a flexible nasal approach airway endoscopy was performed which showed oedematous and intermittently obstructing vestibular folds. Thus, nebulised adrenaline was administered. Subsequently a carbon dioxide laser supraglottoplasty was performed under general anaesthesia to secure the airway, with a total of 29mg of nebulised adrenaline administered in the perioperative period. The morning post-surgery he developed a short run of a broad complex tachycardia with no chest pain. The 12 lead ECG showed widespread tombstone morphology ST-segment elevation not conforming to any vascular territory. He then rapidly developed cardiogenic shock requiring ionotropic support. An urgent angiogram showed only minor irregularities of the coronary arteries. The left ventriculography showed severely reduced left ventricular systolic function with mid cavity and apical wall akinesis, consistent with Takotsubo cardiomyopathy. A transthoracic echocardiogram performed four days later showed an ejection fraction of 53% with no regional wall motion abnormalities, in keeping with complete recovery. We believe this is the first case report of nebulised adrenaline contributing to Takotsubo cardiomyopathy resulting cardiogenic shock. Nebulised adrenaline is considered a lifesaving intervention in upper airway obstruction, however caution with its use is advocated.

Carbon dioxide laser versus cold-steel supraglottoplasty: A comparison of post-operative outcomes

ObjectiveSupraglottoplasty is the mainstay of surgical treatment for laryngomalacia, and is commonly performed via two methods: cold steel or carbon dioxide (CO2) laser. The degree of post-operative monitoring following supraglottoplasty varies, both within and between institutions. The aim of this study was to compare the post-operative monitoring and interventions required by patients undergoing cold-steel versus CO2 laser supraglottoplasty. DesignRetrospective cohort of pediatric patients (age < 18 years) undergoing supraglottoplasty at a tertiary care pediatric hospital. The primary exposure was the surgical instrument(s) used during supraglottoplasty. The primary outcome was prolonged intensive care unit (ICU)-stay (defined as >24 h). Results155 cases were eligible for inclusion. Fifty-eight (37.4%) patients had a comorbid condition. Common indications for surgery included feeding difficulty (56.1%), severe respiratory distress (33.5%), and obstructive sleep apnea (25.2%). CO2 laser was employed in 49 cases and cold-steel in 106 cases. Prolonged ICU-stay (>24 h) was observed in 14 CO2 laser cases (28.6%) and 11 cold-steel cases (10.4%) (adjusted OR 3.42; 95% CI 1.43, 8.33). CO2 laser cases were more likely to require post-operative intubation, non-invasive positive pressure ventilation, and nebulized racemic epinephrine. Concomitant neurological condition was associated with an increased risk of prolonged ICU-stay, while extent of surgery and age were not. ConclusionsCO2 laser supraglottoplasty is associated with an increased risk of prolonged ICU-stay and need for ICU-level airway intervention, compared to the cold-steel technique. While this association should not be misconstrued as a causal relationship, the current study demonstrates that specific surgical factors may influence the patient monitoring requirements following supraglottoplasty, particularly the choice of instrument and the extent of surgery.

Severe Exercise-Induced Laryngeal Obstruction Treated With Supraglottoplasty.

Introduction: Exercise induced laryngeal obstruction (EILO) is relatively common in adolescents, with symptoms often confused with exercise induced asthma. EILO often starts with medial or inward rotation of supraglottic structures of the larynx, whereas glottic adduction appears as a secondary phenomenon in a majority. Therefore, surgical treatment (supraglottoplasty) is used in thoroughly selected and highly motivated patients with pronounced symptoms and severe supraglottic collapse.Aim: To investigate efficacy and safety of laser supraglottoplasty as treatment for severe supraglottic EILO by retrospective chart reviews.Methods: The EILO register at Haukeland University Hospital, Bergen, Norway was used to identify patients who had undergone laser supraglottoplasty for severe supraglottic EILO, verified by continuous laryngoscopy exercise (CLE) test, during 2013–2015. Laser incision in both aryepiglottic folds anterior to the cuneiform tubercles and removal of the mucosa around the top was performed in general anesthesia. Outcomes were questionnaire based self-reported symptoms, and laryngeal obstruction scored according to a defined scheme during a CLE-test performed before and after surgery.Results: Forty-five of 65 eligible patients, mean age 15.9 years, were included. Post-operatively, 38/45 (84%) patients reported less symptoms, whereas CLE-test scores had improved in all, of whom 16/45 (36%) had no signs of obstruction. Most improvements were at the supraglottic level, but 21/45 (47%) also improved at the glottic level. Two of 65 patients had complications; self-limiting vocal fold paresis and scarring/shortening of plica ary-epiglottica.Conclusion: Supraglottoplasty improves symptoms and decreases laryngeal obstruction in patients with severe supraglottic EILO, and appears safe in highly selected cases.

Supraglottoplasty for laryngomalacia: The experience from Concepcion, Chile

ObjectiveTo review the clinical manifestations and outcomes of supraglottoplasty in patients with moderate to severe laryngomalacia at Guillermo Grant Benavente Hospital between January 2015 and January 2017. MethodsRetrospective study of patients with laryngomalacia who underwent CO2 laser supraglottoplasty at a tertiary referral center. A review of medical records of these patients was performed. Epidemiological data along with symptoms, comorbidities, morphological type of laryngomalacia, synchronous airway lesions, surgery outcomes and satisfaction of parents after the procedure were recorded. Surgical success was defined as the resolution of the criteria of severity of laryngomalacia. ResultsTwenty-four patients were operated, 1 was excluded due to prior tracheostomy. Twenty-three patients were included, the median age at the time of surgery was 5.5 months. All the patients had stridor, 87% presented feeding difficulties, 34.8 % had cyanosis and 21.7% had failure to thrive. Six cases had congenital anomalies and four cases had nongenetic comorbidities. Fifteen patients (65.2%) had synchronous airway lesions. 17.4% had type I laryngomalacia and 82.6% were type 2. The postoperative average hospital stay was 1.3 days. The average follow-up was 14 months and no complications were reported. The overall success rate of surgery was 95%. ConclusionsPatients with laryngomalacia and any symptom of severity should undergo a full airway evaluation, to rule out synchronous airway lesions, and supraglottoplasty if needed, as it has been shown to be a safe and effective technique for the management of these patients.

Postoperative Complications After Surgical Treatment For Exercised Induced Laryngeal Obstruction

PURPOSE: Exercised induced laryngeal obstruction (EILO) is a situation in which an apparently normal larynx instead of opening fully during exercise adducts, and thus represents an obstruction to free airflow. In principle, EILO can be primarily glottic or supraglottic. Surgery has been suggested as treatment for highly motivated patients suffering from severe forms of the latter. We would like to report on complications after surgical treatment for supraglottic EILO. METHODS: During 2010-2015, 66 patients underwent laser supraglottoplasty due to a primary severe supraglottic EILO verified using continuous laryngoscopy during exercise. The surgical procedure was performed in general anaesthesia by one of three surgeons. Care was taken to avoid patients with glottic EILO or other upper airway malformations. RESULTS: Of 66 patients operated at mean age 15.8 (range 5-26) years, 43 (65%) were females, three (4.5 %) required two surgical procedures, and 63 (95 %) met for a postoperative follow-up exercise laryngoscopy (mean interval 5.8 months). Complications were reported for two patients: (A) Male, 15 years at surgery, diagnosed with postoperative left recurrent laryngeal nerve palsy. Injury caused by intubation or a direct complication from surgery were possible explanations. A mediastinal mass discovered on chest x-ray and a concomitant Epstein-Barr infection, prompted comprehensive work-up; however, with no conclusive findings. At a second follow-up 1.5 year later, the patient had nearly fully recovered and had no problems performing daily activities. (B) Male, 13 years at surgery, diagnosed with postoperative extensive scarring needing a re-operation. Fifteen months after the last surgery, he still had breathing problems during heavy exercise, but reported no problems performing daily activities. Exercise laryngoscopy performed at that time indicated better laryngeal opening when compared to the findings before the first surgery, despite the postoperative scarring. CONCLUSIONS: Complications were experienced by 2/66 (3%) highly motivated patients operated with supraglottoplasty for severe supraglottic EILO. At follow-up approximately 1.5 years after last surgery, none had symptoms influencing their daily activities.

Laser supraglottoplasty for laryngomalacia; a 14year experience of a tertiary referral center.

To review the outcomes of laser supraglottoplasty performed in children with symptomatic laryngomalacia and determine the factors influencing them. We retrospectively reviewed the medical records of patients who underwent laser supraglottoplasty for symptomatic laryngomalacia at the Lausanne University Hospital from November 2001 to November 2014. We examined the patient's demography, symptoms, comorbidities, type of laryngomalacia, synchronous airway lesions, and final outcomes. Seventy-nine patients were included in this study; median age at the time of surgery was 12.7months. 55.7% of the cases had comorbidities, 22.8% of the patients were premature and synchronous airway lesions were present in 32.9% of the cases. The different morphological types of laryngomalacia (I-III) were seen in 26.6, 62 and 11.4% of the patients, respectively. Overall, operation specific success rate of laser supraglottoplasty was 86.1%. Failures in 11 (13.9%) of the 79 cases required 15 revision procedures. Success rates for patients with associated comorbidities, synchronous airway lesions, neurological disorders and prematurity were 81.8, 76.9, 69.2 and 66.7%, respectively. Patients with type III laryngomalacia had a limited success rate (66.7%) as compared to patients with morphological types I and II (90.5 and 87.8%, respectively). Laser supraglottoplasty is an effective and safe treatment for symptomatic laryngomalacia. Patients with prematurity, type III LM, synchronous airway lesions and associated comorbidities are predisposed to surgical failure.

Early Diagnosis for Mucopolysaccharidosis I - A 6-month-old Female Infant Presenting with Gibbus, Hirsutism and Mongolian Spots in a Well Baby Clinic

Mucopolysaccharidosis (MPS) I is a rare, progressive and multisystemic disease with insidious initial signs and symptoms, and making an early diagnosis can be a challenge for the first-line general medical practitioner. We report a 6-month-old girl who was brought to our well baby clinic for regular immunization with the manifestations of lumbar gibbus, hirsutism, large Mongolian spots over back and buttock, and mild bilateral legs spasticity noticed by the general pediatrician, and then newly diagnosed with MPS I after referral to the geneticist in time. Her surgical history included inguinal hernia repair at 1 month old, <TEX>$CO_2$</TEX> laser supraglottoplasty for laryngomalacia and tracheostomy due to chronic respiratory failure with ventilator dependence at 2 months old. Understanding and identification of the early signs and symptoms of this disease have the potential to early diagnosis and timely appropriate treatment, which could contribute to a better clinical outcome.

Mandibular distraction for Robin sequence associated with laryngomalacia.

Protocols for the treatment of Robin sequence (RS) consider the presence of laryngomalacia as a contraindication to mandibular distraction osteogenesis (MDO). The authors report their institutional experience of MDO applied to infants with RS and associated laryngomalacia. An 8-year (2005-2013) retrospective review of all infants with RS and laryngomalacia who underwent MDO at a tertiary care children's hospital was performed. Patients were excluded if they possessed an airway anomaly other than laryngomalacia. Laryngomalacia was identified on laryngoscopy before MDO. Laser supraglottoplasty was performed at the discretion of the otolaryngologist. Recorded variables included preoperative and postoperative AHI, syndromic diagnosis or genetic anomalies, cardiac, central nervous system (CNS), and gastrointestinal (GI) abnormalities. The primary outcomes measured were avoidance or decannulation of tracheostomy and decrease in postoperative AHI. Eleven infants met inclusion criteria. Mean follow-up was 28 months. 18.2% of patients had a syndromic diagnosis, 36.4% cardiac, 9.1% CNS, and 72.7% GI abnormalities. Mean preoperative AHI was 46.1 ± 31.8 and mean postoperative AHI was 4.1 ± 3.0 (P = 0.002). All patients without a tracheostomy before intervention avoided tracheostomy after MDO. One patient had a tracheostomy before MDO and was subsequently decannulated. One patient died 1 year after MDO due to complex congenital heart disease. Infants with RS and laryngomalacia can be successfully treated with MDO to relieve upper airway obstruction. Close cooperation with a pediatric otolaryngologist and treatment of laryngomalacia can significantly enhance tracheostomy avoidance in infants with Robin sequence.

Larynx during exercise: the unexplored bottleneck of the airways.

Exercise-induced shortness of breath is not uncommon in otherwise healthy young people. Based on the presenting symptoms alone, it is challenging to distinguish exercise-induced asthma (EIA) from exercise-induced obstruction of central airways, sometimes leading to diagnostic errors and inadequate treatment. Central airway obstruction usually presents with exercise-induced inspiratory symptoms (EIIS) during ongoing exercise. EIIS tends to peak towards the end of an exercise session or immediately after its completion, contradicting symptoms of EIA typically peaking 3–15 min after the exercise has stopped. EIIS is usually associated with some form of laryngeal obstruction. Transnasal flexible laryngoscopy performed continuously throughout an incremental exercise test from rest to exhaustion or to intolerable symptoms is usually diagnostic, and also provides information that is important for further handling and treatment. Reflecting the complex anatomy and functional features of the larynx, exercise-induced laryngeal obstruction (EILO) appears to be a heterogeneous condition. Contradicting previous beliefs, recent literature suggests that laryngeal adduction in a majority of cases starts in supraglottic structures and that vocal cord adduction (VCD) most often occurs as a secondary phenomenon. However, EILO is poorly understood and more and better research is needed to unravel causal mechanisms. The evidence base for treatment of EILO is weak. Speech therapy, psychotherapy, biofeedback, muscle training, anticholinergic aerosols have all been applied, as has laser supraglottoplasty. Randomized controlled trials with well-defined and verifiable inclusion and success criteria are required to establish evidence-based treatment schemes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00405-014-3159-3) contains supplementary material, which is available to authorized users.

Management of laryngomalacia in children with congenital syndrome: The role of supraglottoplasty

Background/ImportanceSupraglottoplasty is the surgical procedure of choice for severe laryngomalacia and has shown to be successful in most cases; however, patients with medical comorbidities present a higher rate of failure. To date, the best management of laryngomalacia in children with congenital syndrome remains unclear. PurposeTo study the outcome of supraglottoplasty in children with severe laryngomalacia, and to analyze the management and outcome in infants with a congenital syndrome. MethodsRetrospective medical records review from January 2003 to October 2012 of all patients who underwent laser supraglottoplasty for severe laryngomalacia at the University Children's Hospital Zurich, Switzerland. ResultsThirty-one patients were included; median age at time of surgery was 3.5months. Three patients (10%) had a genetically proven congenital syndrome with associated neurologic anomalies. Overall success rate was 87%. Failures were observed in four (13%) of 31 cases; including all three patients presenting a congenital syndrome. ConclusionsSupraglottoplasty is an effective and safe treatment for laryngomalacia in otherwise healthy children. Signs of a possible underlying predominant neurologic origin and discrepancy between the clinical presentation and the endoscopic findings have to be taken into account, as in children with congenital syndrome with neurologic anomalies the risk of failure is higher.

Adult-onset laryngomalacia: case reports and review of management

Laryngomalacia is a dynamic airway condition characterised by inward collapse of flaccid supraglottic structures during inspiration. Although the most common cause of stridor in the paediatric population, adult-onset laryngomalacia remains a rare entity and its management, challenging. Two cases of adult-onset laryngomalacia are reported. A review of the English literature is performed and additional publications identified by hand-searching relevant papers; 13 case reports/series comprising 28 cases of adult-onset laryngomalacia were identified, divided into two main groups: idiopathic (6/28) and acquired (22/28). The aetiology of the acquired form includes neurological, traumatic and iatrogenic. Reported therapeutic measures used are laser supraglottoplasty, epiglottopexy, partial epiglottidectomy, defunctioning tracheostomy and intubation whilst correcting the underlying cause. The majority of patients only required one therapeutic procedure (follow-up of 2-24 months). A strong index of suspicion is required to diagnose adult-onset laryngomalacia aided by in-office laryngoscopy. The rarity of this condition prevents management-based randomised controlled trials.

Laser Supraglottoplasty via Flexible Endoscope in the Treatment of Severe Laryngomalacia in Infants

Objective: Traditionally, laser supraglottoplasty for the treatment of severe laryngomalacia (SLM) is via rigid endoscopy (RE) with general anesthesia. This study was designed to evaluate the safety and efficacy of the technique of laser supraglottoplasty via flexible endoscope (FE) in the treatment of infantile SLM.Methods: A two-year (2008-2009) prospective study of consecutive infants suffering with SLM was conducted. All the candidate infants were treated with the potassium-titanylphosphate (KTP) laser via a FE after their diagnostic FE under intravenous sedation without any artificial airway. Infants’ clinical variables and prognosis were evaluated. Results: A total of 30 infants were enrolled. Mean age and body weight was 2.5 (±1.2) months and 3.6 (±0.9) kg, respectively. The laser FE was performed 12 (±2.5) minutes after the diagnostic FE and the procedure duration was 16 (±4.2) minutes. No intra-or postoperative complications were observed. Total post-laser hospital day was 6.9 (±1.8) days. Prognosis at the 12-weeks later revealed that 28 infants (93.3%) demonstrated significant clinical improvement without any further stridor. Conclusions: Our study suggests that the supraglottoplasty of FE laser is a convenient, safe (100%) and effective (93.3%) technique. It seems to be an appropriate therapy for treatment of SLM in infants.

Management of supraglottic dysgenesis presenting as laryngomalacia

Laryngomalacia is a common source of stridor and can lead to significant upper airway obstruction and feeding disturbances in infants. We describe a unique case of supraglottic dysgenesis presenting as laryngomalacia featuring a prominent “s-shaped” epiglottis with both posterior edges fused to the right aryepiglottic fold/arytenoid complex. Although this anomaly is not accounted for in any of the current laryngomalacia classification schemes, modified laser supraglottoplasty was a satisfactory approach leading to successful decannulation. Laryngeal embryology and possible timing of the pathogenesis of this rare occurrence are reviewed as well.

Exercise-induced laryngeal obstruction: natural history and effect of surgical treatment

The current follow-up study concerning the supraglottic type of exercise-induced laryngeal obstruction (EILO) was performed to reveal the natural history of supraglottic EILO and compare the symptoms, as well as the laryngeal function in conservatively versus surgically treated patients. A questionnaire-based survey was conducted 2–5 years after EILO was diagnosed by a continuous laryngoscopy exercise (CLE) test in 94 patients with a predominantly supraglottic obstruction. Seventy-one patients had been treated conservatively and 23 with laser supraglottoplasty. The questionnaire response rate was 70 and 100% in conservatively treated (CT) and surgically treated (ST) patients, respectively. A second CLE test was performed in 14 CT and 19 ST patients. A visual analogue scale on symptom severity indicated improvements in both the groups, i.e. mean values (± standard deviations) declined from 73 (20) to 53 (26) (P < 0.001) in the CT group and from 87 (26) to 25 (27) (P < 0.001) in the ST group. At follow-up, ST patients reported lower scores regarding current level of complaints, and higher ability to perform exercise, as well as to push themselves physically, all compared to CT patients (P < 0.001). CLE scores were normalized in 3 of 14 (21%) CT and 16 of 19 (84%) ST patients (Z = −3.6; P < 0.001). In conclusion, symptoms of EILO diagnosed in adolescents generally decreased during 2–5 years follow-up period but even more after the surgical treatment. Patients with supraglottic EILO may benefit from supraglottoplasty both as to laryngeal function and symptom relief. Level of evidence 2b, individual retrospective cohort study.

Comparison between rigid and flexible laser supraglottoplasty in the treatment of severe laryngomalacia in infants

Objective Traditionally, laser supraglottoplasty for the treatment of severe laryngomalacia (SLM) is via rigid endoscopy (RE). Potassium-titanyl-phosphate (KTP) laser fiber can pass through a flexible endoscopy (FE) and cauterize tissue. This study is designed to evaluate and compare clinical variables between these two techniques in the treatment of SLM in infants. Methods A retrospective study includes four-year period of consecutive infants who received laser supraglottoplasty. In the first two years (2006–2007), conventional RE CO 2-laser with general anesthesia and endotracheal intubation were used. In the latter two years (2008–2009), a novel technique of FE KTP-laser with intravenous sedation, nasopharyngeal oxygen and a noninvasive respiratory support (if indicated), without any artificial airway was used immediately after the diagnostic FE. After laser surgery, infants were followed for three months. Clinical variables were analyzed and compared. Results A total of 57 infants (27 in RE group, 30 in FE group) were enrolled. Basic variables were similar between both groups. Clinical improvement was comparable with 88.9% and 93.3% in the RE and FE groups, respectively. There are no significant differences in mean number of laser surgery, major complications, duration of post-laser respiratory support and hospitalization days, body weight percentile between the two groups. However, the durations of waiting time, operation, ET intubation and total hospital days were significantly less in the FE group. Conclusions FE technique has similar success rate but more convenient and cost-effective than the RE technique. It may to be a practical alternative therapy for infants with SLM.

Management of Supraglottic Dysgenesis Presenting as Laryngomalacia

Abstract Laryngomalacia is a common source of stridor and can lead to significant upper airway obstruction and feeding disturbances in infants. We describe a unique case of supraglottic dysgenesis presenting as laryngomalacia featuring a prominent “s-shaped” epiglottis with both posterior edges fused to the right aryepiglottic fold/arytenoid complex. Although this anomaly is not accounted for in any of the current laryngomalacia classification schemes, modified laser supraglottoplasty was a satisfactory approach leading to successful decannulation. Laryngeal embryology and possible timing of the pathogenesis of this rare occurrence are reviewed as well.

Tracheal foreign body after laser supraglottoplasty: A hidden but risky complication of an aluminum foil tape-wrapped endotracheal tube

Wrapping of the endotracheal tube with aluminum foil tape can prevent laser-beam-induced ignition of the tube during laryngoplasty. However, this modified endotracheal tube may pose complications. Two newborn infants had a portion of the foil tape trapped in their trachea after extubation from laser supraglottoplasty. One infant was totally asymptomatic. The other infant‘s symptoms were masked by the concurrent tracheomalacia. Both residual tapes were radiolucent on chest radiographs. Flexible endoscopy was the suitable and safe modality for an accurate diagnosis and immediate retrieval of the residual tapes in one session.