LARYNGOMALACIA

DO FLEXIBLE EXAM—2 PASEES THROUGH THE NOSE

NEED TO SEE NL VOCAL CORD MOTION!

MOST COMMON CAUSE OF INFANTILE STRIDOR–>60% OF LARYNGEAL PROBLEMS IN INFANTS

A HARSH INSP STRIDOR—WORSE WITH AGITATION—SEEMS TOABATE WITH SLEEP(DO NOT GET SLEEP STUDY–ALTHOUGH HYPOTONIA MAY ALSO CONTRIBUTE TO OSA),POOR FEEDING–FTT—MUST MONITOR WEIGHT!, WORSE WITH AGITATION,WORSE SUPINE,WORSE EXTENDING THE HEAD, BETTER PRONE, BETTER FLEXING THE HEAD

FLACCID SUPRAGLOTTIC STRUCTURES–NO DIFFERENCE IN CARTILAGE–NOT MORE COMMON IN PREMIES–THOUGHT TO BE THE RESULT OF HYPOTONIA/FLACCIDITY OF SUPRAGLOTTIC STRUCTURES

LONG OMEGA SHAPED EPIGLOTTIS—OMEGA SHAPE ALLOWS THE ARYTENOIDS TO FALL IN CLOSER TO THE MIDLINE, LARGE ARYTENOIDS AND CUNEIFORMS WITH REDUNDANT MUCOSA, FORESHORTENED A-E FOLDS—–A LOT OF POST/LAT COLLAPSE CORRELATES WELL WITH THE NEED FOR AN ENDOSCPOPIC SUPRAGLOTTOPLASTY!

REALLY 4 SUBTYPES

GENERALLYONSET WITHIN FIRST 4-6 WKS (2-6 WEEKS) AFTER BIRTH(OFTEN FIRST 10 DAYS)—USUALLY PROGRESSES SOME UP TO 6 MONTHSAND THEN ABATES–PRIMARILY RESOLVES BY AGE 2

75% ASSOC, GERD—SO TREAT IT!, HYPOTONIA ASSOC WITH OSA—?T&A—-ALSO ASSOC WITH FTT

 

UP TO 5% INCIDENCE OF SURGICALLY TREATABLE 2ND AIRWAY ANOMALY—ARGUMENT FOR RIDGID ENDOSCOPY

Rx: OBS, CPAP,ENDOSCOPICSUPRAGLOTTOPLASTYIF NECESSARY(5-10%)—ERRONOUSLY CALLED EPIGLOTTOPLASTY IN PAST–REALLY JUST CUT THE A-E FOLDS—RELEASE THEM(LASER OR COLD STEEL)—IF REFRACTORY TO THIS MAY AMPUTATE 1 (ONLY) CUNEIFORM CARTILAGE—DO ONE SIDE AT A TIME

TREAT REFLUX, ABX, STEROIDS, REASSURANCE AND TIME—INTERVENE WITH WT LOSS, POOR FEDING, CYANOSIS–OTHERWISE OBSERVE—NEVER HESITATE TO GET A 2ND OPINION!! AN ANNOYED PUT OUT PARENT IS BETTER THAN A DEVASTATED ONE.

NEW ENTITY DESCRIBE CALLED “STATE DEP LARYNGOMALACIA”—-(NEUROGENIC)—DEV STRIDOR WHEN ASLEEP—THE NEUROLOGICALLY IMPARED CHILD IS REALLY A DIFFERENT ANIMAL—DIFFUSE PHARYNGEAL HYPOTONIA