Endoscopic surgical management for laryngomalacia. Case report and review of the literature.

Laryngomalacia is the most common of the many causes of respiratory stridor in the newborn. It may be identified by fiberoptic nasopharyngoscopy in the nursery or office. Several anatomic mechanisms of supraglottic collapse have been reported in the literature. The most common is a narrowing of the supraglottic airway with blockage of the glottic opening by the redundant tissue of the aryepiglottic folds. Although surgery rarely is indicated, severe airway obstruction, necessitating surgical intervention, can occur. Resection of supraglottic tissue should be performed only as an alternative to tracheotomy. Surgical procedures ranging from tracheotomy to epiglottidectomy have been advocated. Direct visualization of the obstructing tissue by nasopharyngoscopy allows the planning of an appropriate surgical procedure. In a patient with lateral supraglottic collapse, deep resection of the epiglottis would be expected to weaken the support of the aryepiglottic folds and aggravate the airway condition. Similarly, resection of tissue along the aryepiglottic folds will be useful only if preoperative evaluation demonstrates the obstruction to be at this location.