Laryngomalacia is a common condition. Although the symptoms are generally mild and tend to disappear before the age of 2, their severity in some cases can lead to significant consequences, requiring surgical intervention.
1. Definition of laryngomalacia
According to the definition of the University Hospitals of Marseille, laryngomalacia represents the most common congenital laryngeal malformation, thus becoming the main cause of stridor in newborns, infants and small children. Originally referred to as “congenital laryngeal stridor”, this name accurately reflects the clinical presentation of the malformation. From an anatomical point of view, laryngomalacia is characterized by excess mucosa in the supraglottic region. In its current manifestation, stridor manifests itself from birth or in the first days following it. It is distinguished by a generally high pitch, without alteration of the cry. The severity of laryngomalacia does not necessarily correlate with the intensity of stridor. Its evaluation is based, on the one hand, on the duration of feedings as a reflection of feeding difficulties, which can quickly lead to an interruption of weight growth, and on the other hand, on the possible presence of dyspnea.
2. Causes of laryngomalacia
The epidemiology of laryngomalacia remains poorly understood. The precise mechanisms underlying this condition are not fully understood, but several hypotheses have been put forward, including abnormalities in the shape and structure of the larynx, structural differences in cartilage, neurosensory dysfunction leading to poor neuromuscular coordination. airways, and the frequent presence of gastroesophageal reflux in affected children.
3. Symptoms of laryngomalacia
In most cases, the symptoms of laryngomalacia remain mild and include the following:
The first signs generally appear during the first ten days and tend to progress, stabilizing around the age of 6 to 8 months. In most situations, the tissues tend to solidify over time, no longer obstructing the airways, and the symptoms gradually diminish and disappear between the child’s 12 and 24 months of age. However, between 10 and 20% of infants, depending on the Swiss medical journal, will present more serious forms of the disease, requiring surgical intervention. Additional tests may be prescribed to look for other pathologies, including gastroesophageal reflux disease or GERD. The link between the two can be explained by airway obstruction due to laryngomalacia favoring reflux to the esophagus and reduced tone of the esophageal sphincter in children with laryngomalacia.
4. Laryngomalacia: what treatments?
Most cases of mild laryngomalacia are treated conservatively with regular clinical monitoring. Hygiene-dietary measures, such as the use of thickened milk, an inclined position during and after meals, and elevation of the head of the bed are recommended to act on the associated gastroesophageal reflux. Although the usefulness of antireflux drugs is controversial, their introduction is recommended in the presence of symptoms such as cough, regurgitation or difficulty eating. Severe cases of laryngomalacia require surgical treatment with supraglottoplasty. Indications include failure to thrive, severe dyspnea, episodes of respiratory distress, obstructive sleep apnea, feeding problems, or late chronic signs of airway obstruction.
Supraglottoplasty is an endoscopic procedure aimed at reducing excess tissue in the supraglottic structures. Different surgical techniques can be used, such as the use of the CO2 laser, as specified by the airway unit of the ENT department of the Vaudois University Hospital (Chuv). The results do not show significant differences between the different techniques. The procedure typically involves sectioning of the aryepiglottic folds, resection of excess mucosa, suspension of the epiglottis, or a combination of these techniques. Supraglottoplasty is generally performed using suspension microlaryngoscopy with a CO2 laser Lindholm spatula, under deep sedation in successive apneas to ensure complete immobility of the larynx during the procedure.
Sources
- Laryngomalacia, Marseille University Hospitals
- Laryngomalacia: main cause of stridor in infants and young children, Swiss Medical Review, October 1, 2014
- Laryngomalacia, Airway Unit, ENT Department of the Vaudois University Hospital, May 29, 2018
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