Givens V, Brent K, Dunham M, Kanotra S P
Department of Otolaryngology,Louisiana State University,Children's Hospital New Orleans,USA.
Department of Pediatric Gastroenterology,Louisiana State University,Children's Hospital New Orleans,USA.
J Laryngol Otol. 2018 Sep;132(9):852-855. doi: 10.1017/S0022215118000713. Epub 2018 Jun 18.
To describe a case of concurrent cricopharyngeal achalasia with laryngomalacia as a cause of failure to thrive, and to review the literature and management options of cricopharyngeal achalasia in the paediatric population.
A chart review was performed on a four-month-old male, referred for failure to thrive, and diagnosed with cricopharyngeal achalasia and laryngomalacia. A PubMed and Embase search for 'cricopharyngeal achalasia' and 'laryngomalacia' was conducted. A review of reported paediatric cricopharyngeal achalasia patients, with emphasis on management options, was undertaken.
A flexible laryngoscopic examination confirmed the laryngomalacia diagnosis, and videofluoroscopic evaluation of swallowing demonstrated cricopharyngeal achalasia via a cricopharyngeal bar. Supraglottoplasty was performed, with botulinum toxin injection into the cricopharyngeus muscle, with resultant improvement in oral intake and resolution of failure to thrive. The literature review revealed no reported case of the combined pathologies as a cause of failure to thrive.
Functional endoscopic evaluation of swallowing and videofluoroscopic evaluation of swallowing are complimentary in the evaluation of paediatric patients with failure to thrive and suspected oropharyngeal dysphagia. Both supraglottoplasty and botulinum toxin injection are effective for definitive management in cases of combined pathology, and can be safely performed in a single surgical setting.
描述一例并发环咽肌失弛缓症和喉软化症导致发育不良的病例，并回顾儿科人群中环咽肌失弛缓症的文献及治疗选择。
对一名因发育不良前来就诊并被诊断为环咽肌失弛缓症和喉软化症的4个月大男性患儿进行病历回顾。在PubMed和Embase上检索“环咽肌失弛缓症”和“喉软化症”。对已报道的儿科环咽肌失弛缓症患者进行综述，重点关注治疗选择。
灵活喉镜检查确诊为喉软化症，吞咽视频荧光造影评估通过环咽肌条显示环咽肌失弛缓症。进行了声门上成形术，并向环咽肌注射肉毒杆菌毒素，患儿经口摄入量增加，发育不良问题得到解决。文献综述显示，尚无将这两种合并病变作为发育不良病因的报道病例。
吞咽功能内镜评估和吞咽视频荧光造影评估在评估发育不良且疑似口咽吞咽困难的儿科患者时互为补充。声门上成形术和肉毒杆菌毒素注射对合并病变的确定性治疗均有效，且可在单一手术环境中安全实施。
