Clin Exp Otorhinolaryngol.  2021 Nov;14(4):414-423. 10.21053/ceo.2020.02061.

Feasibility of Surgical Treatment for Laryngomalacia Using the Spontaneous Respiration Technique

• Cha H
• Lee DY
• Kim EH
• Lee JH
• Jang YE
• Kim HS
• Kwon SK

• KMID: 2522433
• DOI: http://doi.org/10.21053/ceo.2020.02061

Abstract

Objectives
. In this study, we review our institutional experience with pediatric laryngomalacia (LM) and report our experiences of patients undergoing supraglottoplasty using the spontaneous respiration using intravenous anesthesia and high-flow nasal oxygen (STRIVE Hi) technique.
Methods
. The medical records of 29 children with LM who visited Seoul National University Hospital between January 2017 and March 2019 were retrospectively reviewed. Surgical management was performed using the STRIVE Hi technique. Intraoperative findings and postoperative surgical outcomes, including complications and changes in symptoms and weight, were analyzed.
Results
. Of the total study population of 29 subjects, 20 (68.9%) were female. The patients were divided according to the Onley classification as follows: type I (n=13, 44.8%), II (n=10, 34.5%), and III (n=6, 20.7%). Twenty-five patients (86.2%) had comorbidities. Seventeen patients (58.6%) underwent microlaryngobronchoscopy under STRIVE Hi anesthesia. Four patients with several desaturation events required rescue oxygenation by intermittent intubation and mask bagging during the STRIVE Hi technique. However, the procedure was completed in all patients without any severe adverse effects. Overall, 15 children (51.7%) underwent supraglottoplasty, of whom 14 (93.3%) showed symptom improvement, and their postoperative weight percentile significantly increased (P=0.026). One patient required tracheostomy immediately after supraglottoplasty due to associated neurological disease.
Conclusion
. The STRIVE Hi technique is feasible for supraglottoplasty in LM patients, while type III LM patients with micrognathia or glossoptosis may have a higher risk of requiring rescue oxygenation during the STRIVE Hi technique.

Keyword

Laryngomalacia; Airway Management; STRIVE Hi; Anesthesia; Surgical Procedure; Supraglottoplasty

Figure

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  Fig. 1. Supraglottoplasty techniques for each type of laryngomalacia. (A) Type I, excision of short and redundant aryepiglottic fold. (B) Type II, lateral partial epiglottectomy in addition to the procedure used for type I. (C) Type III, excision of short aryepiglottic fold with epiglottopexy of after laser vaporization of epiglottis.

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  Fig. 2. Flowchart for anesthesia maintenance and events.

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  Fig. 3. Weight percentile change after surgery. Patients with supraglottoplasty showed significant changes in weight percentile (P = 0.026).

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