Division of Pediatric Otolaryngology-Head and Neck Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago Illinois, IL, USA.
Ann Otol Rhinol Laryngol. 2023 Nov;132(11):1393-1399. doi: 10.1177/00034894231160693. Epub 2023 Mar 24.
Severe laryngomalacia, characterized by apnea, hypoxia, and feeding difficulties, is an uncommon diagnosis that often requires surgical intervention with supraglottoplasty. Children who require surgery at a young age and those with additional comorbidities pose a special challenge and may require further surgical interventions. Posterior displacement of the epiglottis has been noted in some infants with congenital stridor and is commonly treated with epiglottopexy. The goal of our study is to review the outcomes of epiglottopexy combined with supraglottoplasty in our cohort of infants younger than 6 months old with severe laryngomalacia.
A retrospective chart review of infants younger than 6 months old who underwent epiglottopexy combined with supraglottoplasty for severe laryngomalacia from January 2018 to July 2021 at a tertiary care children's hospital.
13 patients (age 1.3 week-5.2 months) underwent supraglottoplasty and epiglottopexy for severe laryngomalacia and epiglottis retroflection. The patients were admitted to the intensive care unit and remained intubated for at least one night. All patients demonstrated subjective and objective improvement in upper airway respiratory signs and symptoms. Ten patients demonstrated aspiration immediately postoperatively, despite 4 of them having no concern for aspiration at preoperative evaluation. On follow-up, 1 patient required revision supraglottoplasty and epiglottopexy for persistent laryngomalacia, and 2 patients required tracheostomy tube placement due to cardiopulmonary comorbidities.
Infants younger than 6 months old with medical comorbidities undergoing epiglottopexy with supraglottoplasty may demonstrate significant improvement in respiratory symptoms. Worsening dysphagia may complicate the postoperative period, particularly among children with medical comorbidities.
重度喉软化症的特征为呼吸暂停、缺氧和喂养困难，是一种罕见的诊断，通常需要通过悬雍垂成形术进行手术干预。年龄较小且存在其他合并症的患儿会带来特殊的挑战，可能需要进一步的手术干预。一些患有先天性喘鸣的婴儿会出现会厌后移位，通常采用会厌固定术进行治疗。我们的研究目的是回顾在我院年龄小于 6 个月的重度喉软化症患儿中，联合行会厌固定术和悬雍垂成形术的治疗效果。
回顾性分析 2018 年 1 月至 2021 年 7 月期间在一家三级儿童医院因重度喉软化症行会厌固定术联合悬雍垂成形术的年龄小于 6 个月的婴儿病历。
13 例（年龄 1.3 周-5.2 月）患儿因重度喉软化症和会厌后反行悬雍垂成形术和会厌固定术。所有患者均入住重症监护病房，至少需接受 1 晚的气管插管。所有患者的上呼吸道呼吸症状和体征均有主观和客观改善。尽管术前评估中有 4 例患儿无吞咽问题，但 10 例患儿术后均即刻发生了误吸。随访时，1 例患者因持续存在的喉软化症需再次行悬雍垂成形术和会厌固定术，2 例患者因心肺合并症需行气管造口术。
有医疗合并症的年龄小于 6 个月的婴儿行会厌固定术联合悬雍垂成形术，其呼吸症状可能会显著改善。吞咽困难恶化可能会使术后情况复杂化，特别是对于有医疗合并症的患儿。
