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Journal of Multidisciplinary Healthcare 2017Robin sequence (RS) is a commonly encountered triad of micrognathia, glossoptosis, and airway obstruction, with or without a cleft palate. The management of airway... (Review)
Review
Robin sequence (RS) is a commonly encountered triad of micrognathia, glossoptosis, and airway obstruction, with or without a cleft palate. The management of airway obstruction is of paramount importance, and multiple reviews and retrospective series outline the diagnosis and treatment of RS. This article focuses on the multidisciplinary nature of RS and the specialists' contributions and thought processes regarding the management of the RS child from birth to skeletal maturity. This review demonstrates that the care of these children extends far beyond the acute airway obstruction and that thorough monitoring and appropriate intervention are required to help them achieve optimal outcomes.
PubMed: 28392703
DOI: 10.2147/JMDH.S98967 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Aug 2023To explore the perioperative airway management and treatment of newborns with micrognathia and laryngomalacia. From January to December 2022, a total of 6 newborns with...
To explore the perioperative airway management and treatment of newborns with micrognathia and laryngomalacia. From January to December 2022, a total of 6 newborns with micrognathia and laryngomalacia were included. Preoperative laryngoscopy revealed concomitant laryngomalacia. These micrognathia were diagnosed as Pierre Robin sequences. All patients had grade Ⅱ or higher symptoms of laryngeal obstruction and required oxygen therapy or non-invasive ventilatory support. All patients underwent simultaneous laryngomalacia surgery and mandibular distraction osteogenesis. The shortened aryepiglottic folds were ablated using a low-temperature plasma radiofrequency during the operation. Tracheal intubation was maintained for 3-5 days postoperatively. Polysomnography(PSG) and airway CT examination were performed before and 3 months after the surgery. Among the 6 patients, 4 required oxygen therapy preoperatively and 2 required non-invasiveventilatory support. The mean age of patients was 40 days at surgery. The inferior alveolar nerve bundle was not damaged during the operation, and there were no signs of mandibular branch injury such as facial asymmetry after the surgery. Laryngomalacia presented as mixed type: type Ⅱ+ type Ⅲ. The maximum mandibular distraction distance was 20 mm, the minimum was 12 mm, and the mean was 16 mm. The posterior airway space increased from a preoperative average of 3.5 mm to a postoperative average of 9.5 mm. The AHI decreased from a mean of 5.65 to 0.85, and the lowest oxygen saturation increased from a mean of 78% to 95%. All patients were successfully extubated after the surgery, and symptoms of laryngeal obstruction such as hypoxia and feeding difficulties disappeared. Newborns with micrognathia and laryngomalacia have multi-planar airway obstruction. Simultaneous laryngomalacia surgery and mandibular distraction osteogenesis are safe and feasible, and can effectively alleviate symptoms of laryngeal obstruction such as hypoxia and feeding difficulties, while significantly improving the appearance of micrognathia.
Topics: Humans; Infant, Newborn; Infant; Micrognathism; Laryngomalacia; Treatment Outcome; Mandible; Airway Obstruction; Intubation, Intratracheal; Laryngeal Diseases; Osteogenesis, Distraction; Oxygen; Retrospective Studies
PubMed: 37551568
DOI: 10.13201/j.issn.2096-7993.2023.08.004 -
Turkish Archives of Otorhinolaryngology Dec 2016The aim of this study is to analyse the clinical symptoms, follow-up and treatment properties of the laryngomalacia patients that we encountered between 2009 and 2014.
OBJECTIVE
The aim of this study is to analyse the clinical symptoms, follow-up and treatment properties of the laryngomalacia patients that we encountered between 2009 and 2014.
METHODS
Records of 81 laryngomalacia patients who were followed up in our clinic between 2009 and 2014 were retrospectively analysed. Patients' gender, age, time of onset of the symptoms, chief complaints, other co-existing congenital laryngeal anomalies and treatment and follow-up properties were evaluated.
RESULTS
Of the 81 patients, 48 were male and 33 were female, and the mean age was 4.9 months. The average period of follow-up was 12.1 months. The chief complaints at the time of admission were stridor (100%) and episodic cyanosis with feeding (27.16%). Symptoms of 75 patients were resolved at an average of 8.2 months with conservative treatment. Three patients underwent supraglottoplasty. Tracheotomy and posterior cordotomy was performed for a patient with co-existing vocal cord paralysis. Additional tracheotomy was necessary for a patient with pulmonary co-morbidities and for another with co-existing subglottic stenosis.
CONCLUSION
Laryngomalacia is the most common cause of stridor in infants. The majority of laryngomalacia patients can be managed conservatively by close follow-up. For patients in whom respiratory and feeding problems persist or growth retardation develops, surgical treatment is performed. Tracheotomy may be necessary for a small group of patients with additional diseases.
PubMed: 29392037
DOI: 10.5152/tao.2016.1852 -
Cureus Oct 2023Laryngomalacia (LM) is defined as the collapse of supraglottic structures during inspiration, resulting in intermittent airflow impedance and associated stridor. LM is...
Laryngomalacia (LM) is defined as the collapse of supraglottic structures during inspiration, resulting in intermittent airflow impedance and associated stridor. LM is the most prevalent cause of congenital stridor in newborns. The aim of this study is to determine the features and associated comorbidities of LM in Saudi Arabia and to delineate the diagnostic and therapeutic measures used, based on the severity of the case and related comorbidities. This is a three-year retrospective study of children diagnosed with LM and treated in the pediatric otorhinolaryngology outpatient clinic at Maternity and Children Hospital, Dammam, Saudi Arabia, between January 2018 and January 2022. The inclusion criteria were patients with signs and symptoms of LM who are younger than 14 years old. The diagnosis of LM was based on clinical evaluation and confirmed by nasopharyngolaryngoscopy in awake patients and/or direct laryngoscopy and scoping under general anesthesia with spontaneous ventilation for dynamic evaluation. The Olney classification was used for the morphological classification of LM. The exclusion criteria were patients lost to follow-ups. Follow-up duration was two years minimum. A total of 52 patients were included in the study. Among the participants, females accounted for 71% and males accounted for 29% of cases. Our results were in accordance with the relevant literature, except for the higher prevalence of LM in full-term neonates who were found to account for 69.2% of the cases. Understanding the patterns and characteristics of breathing may help clinicians distinguish the noisy breathing of LM from other illnesses because infants are frequently misdiagnosed with these conditions.
PubMed: 38022359
DOI: 10.7759/cureus.47432 -
Journal of Voice : Official Journal of... Jan 2010Lasers are a relatively recent addition to laryngeal surgery. Since their invention, laser use and applications have expanded rapidly. In this article, we discuss the... (Review)
Review
Lasers are a relatively recent addition to laryngeal surgery. Since their invention, laser use and applications have expanded rapidly. In this article, we discuss the benefits and disadvantages of lasers for different procedures, as well as ways to overcome commonly faced clinical problems. The use of lasers in surgery has offered a time- and cost-efficient alternative to cold surgical techniques, and has been used in the treatment of numerous laryngeal pathologies, including stenoses, recurrent respiratory papillomatosis, leukoplakia, nodules, malignant laryngeal disease, and polypoid degeneration (Reinke's edema). However, lasers can incur adjacent tissue damage and vocal fold scarring. These problems can be minimized through understanding the mechanisms by which lasers function and correctly manipulating the parameters under a surgeon's control. By varying fluence, power density, and pulsation, tissue damage can be decreased and lasers can be used with greater confidence. The various types of lasers and their applications to the treatment of specific pathologies are reviewed with the intention of helping surgeons select the best tool for a given procedure. Recent applications of lasers to treat benign laryngeal lesions and severe laryngomalacia demonstrate that additional research must be conducted to realize the full potential of this surgical tool.
Topics: Humans; Laryngeal Diseases; Larynx; Laser Therapy; Otorhinolaryngologic Surgical Procedures
PubMed: 19487102
DOI: 10.1016/j.jvoice.2008.09.006 -
[Analysis of clinical characteristics and surgical efficiency of severe laryngomalacia in children].Lin Chuang Er Bi Yan Hou Tou Jing Wai... Apr 2022To analyze the clinical characteristics and factors affecting surgical efficiency in children with severe laryngomalacia. Retrospectively collect medical records of...
To analyze the clinical characteristics and factors affecting surgical efficiency in children with severe laryngomalacia. Retrospectively collect medical records of children with severe laryngomalacia who underwent supraglottoplasty in Children's Hospital of Chongqing Medical University between January 1, 2015 and May 1, 2019. And analyze the clinical characteristics, the improvement of main symptoms at different time points, and the influence factors on the surgical efficiency. According to the anatomical classification of severe laryngomalacia, type Ⅳ accounted for the highest proportion(66.1%), and type Ⅰ was the lowest(3.6%). All children had stridor and dyspnea, 82.1% cases presented feeding difficulties, and 67.9% cases presented failure to thrive. The proportion of children with medical comorbidities was 62.5%, of which congenital heart disease had the highest incidence(39.3%) The surgical efficiency of severe laryngomalacia without comorbidities was 100.0%, with one type of comorbidity was 96.0%, with multiple comorbidities was 30.0%(<0.01). Stridor, dyspnea, feeding difficulties were significantly improved at one month after surgery in most cases. In the group of surgical age less than 3 months, the surgical efficiency were 61.5%, 61.5% and 69.2% at 1, 3, 6 months after surgery, respectively; the surgical efficiency of children without comorbidities were 100.0%(>0.05) at 1, 3 ,6 months after surgery. In the group of surgical age older than 3 months, the surgical efficiency of children were 100.0% at 1, 3, 6 months after surgery regardless with or without comorbidities. The surgical failure rate and reoperation rate in children without comorbidities was 0, but in the children with comorbidities were 22.9%(<0.05) and 20.0%(<0.05), respectively. The surgical failure rate and reoperation rate in children with multiple comorbidities was significantly higher than children with only one comorbidity(70.0% vs. 4.0%; 60.0% vs. 4.0%, <0.01). The overall operation success rate was 85.7% in severe laryngomalacia children in our hospital. Most children with severe laryngomalacia are associated with multiple medical comorbidities, and with more complex anatomical types. Supraglottoplasty can effectively improve the symptoms in most children with severe laryngomalacia. The existence of multiple comorbidities is the main cause of surgical failure.
Topics: Child; Dyspnea; Glottis; Humans; Infant; Laryngomalacia; Respiratory Sounds; Retrospective Studies; Treatment Outcome
PubMed: 35511616
DOI: 10.13201/j.issn.2096-7993.2022.04.004 -
Sleep Science (Sao Paulo, Brazil) 2022Cyclic alternanting pattern (CAP) has been considered a marker of sleep instability in children. The aim of this study was to evaluate the CAP in infants with...
OBJECTIVE
Cyclic alternanting pattern (CAP) has been considered a marker of sleep instability in children. The aim of this study was to evaluate the CAP in infants with laryngomalacia.
MATERIAL AND METHODS
CAP were quantified in 15 infants with laryngomalacia (mean age 167.2±97.21 days) and 10 controls (mean age of 158.5±116.2 days) using polysomnography.
RESULTS
The distribution of the A2 subtypes across NREM stages in infants with laryngomalacia showed a decrease, as well as in the mean duration of CAP sequences. The A3 CAP and arousals increased in infants with laryngomalacia. Our data showed a stronger correlation between the mean duration of A1 CAP and the age in healthy controls than in infants with laryngomalacia. In accordance to previous reports infants with laryngomalacia exhibited an increase in total awake time, apnea-hypopnea index, and a decrease in N3 stage compared to controls.
DISCUSSION
Our findings add to a growing body of literature of CAP as an indicator of brain maturation.
PubMed: 35273771
DOI: 10.5935/1984-0063.20210017 -
Saudi Medical Journal Apr 2020To correlate the clinical severity of laryngomalacia (LM) with endoscopic findings, swallowing evaluations and polysomnography in a cohort of patients. Method: We...
OBJECTIVE
To correlate the clinical severity of laryngomalacia (LM) with endoscopic findings, swallowing evaluations and polysomnography in a cohort of patients. Method: We conducted a retrospective analysis between 2017-2018 on a cohort of patients diagnosed with upper airway obstruction (UAO), stridor, noisy breathing or laryngomalacia. This study took place at the Pediatric Pulmonology Department, Riley Children's Hospital, Indianapolis, United States of America.
RESULTS
There were 157 patients with laryngomalacia included in the study. Patients with severe LM were significantly younger than those with mild LM (p=0.0214) and moderate LM (p=0.0220). Subjects with type I of LM were significantly older than type III (p=0.0051). When associations were tested between polysomnogram (PSG) variables and clinical severity, there were significant associations with age at PSG. The overall apnea-hypopnea index (AHI) in mild (p=0.0103) and moderate (p=0.0242) were significantly lower than the severe group. The rapid eye movement (REM) AHI was significantly lower in moderate cases than severe (p=0.0134). The end-tidal carbon dioxide (EtCO2) peak was significantly lower in mild cases than severe (p=0.0141). The total sleep time (TST) peripheral capillary oxygen saturation (SpO2) 90% occurs in both mild (p=0.0197) and moderate (p=0.0498) were significantly lower than the severe group.
CONCLUSIONS
The severity of the clinical manifestations of LM did not correlate with the different endoscopic types in our study. The presence of cyanosis was associated with type III LM. Rapid eye movement AHI and EtCO2 in polysomnogram were remained significantly associated with clinical severity.
Topics: Airway Obstruction; Cyanosis; Endoscopy; Female; Humans; Infant; Laryngomalacia; Male; Oximetry; Polysomnography; Respiratory Sounds; Retrospective Studies; Severity of Illness Index; Sleep, REM
PubMed: 32291428
DOI: 10.15537/smj.2020.4.25014 -
International Archives of... Jan 2024Laryngomalacia is the most common congenital laryngeal alteration, with spontaneous resolution in most cases. However, in the face of more severe presentations of... (Review)
Review
Laryngomalacia is the most common congenital laryngeal alteration, with spontaneous resolution in most cases. However, in the face of more severe presentations of the disease, it is necessary to perform supraglottoplasty surgery. Studies have been dedicated to researching changes in swallowing in children with laryngomalacia before and after surgical intervention. To identify the prevalence of oropharyngeal dysphagia in children with pre and postsupraglottoplasty laryngomalacia. A search strategy was developed with terms and entreterms to designate a population , exposure , and outcome , adapted to the requirements of the main databases in the health area. The analysis of the records found was performed by two independent examiners and, in the end, 6 articles were included in the study. The articles found enabled a sample of 330 children with laryngomalacia, 311 of whom underwent supraglottoplasty. Among the included studies, 5 were grouped and meta-analyzed. After supraglottoplasty surgery, a 59% reduction in the prevalence of oropharyngeal dysphagia was identified, with high heterogeneity I = 93%. Despite the heterogeneity of the sample, the supraglottoplasty procedure significantly reduces the prevalence of dysphagia in children with laryngomalacia.
PubMed: 38322449
DOI: 10.1055/s-0042-1755309 -
European Annals of Otorhinolaryngology,... Sep 2018Small children with tracheostomy are at potential risk and have very specific needs. International literature describes the need for tracheostomy in 0.5% to 2% of...
INTRODUCTION
Small children with tracheostomy are at potential risk and have very specific needs. International literature describes the need for tracheostomy in 0.5% to 2% of children following intubation. Reports of children submitted to tracheostomy, their characteristics and needs are limited in developing countries and therefore there is a lack of health programs and government investment directed to medical and non-medical care of these patients. The aim of this study was to describe the characteristics of these children and identify problems related to or caused by the tracheostomy.
METHODS
A retrospective cohort study was performed based on a common database applied in four high complexity healthcare facilities to children submitted to tracheostomy from January 2013 to December 2015. Data concerning children's demographics, indication for tracheostomy, early and late complications related to tracheostomy, airway diagnosis, comorbidities and decannulation rates are reported. Patients who did not present a complete database or had a follow-up of less than six months were excluded.
RESULTS
A total of 160 children submitted to tracheostomy during the three-year period met the criteria and were enrolled in this study. Median age at tracheostomy was 6.9 months (ranging from 1 month to 16 years, interquartile range of 26 months). Post-intubation laryngitis was the most frequent indication (48.8%). Comorbidities were frequent: neurologic disorders were reported in 40%, pulmonary pathologies in 26.9% and 20% were premature infants. Syndromic children were 23.1% and the most frequent was Down's syndrome. The most common early complication was infection that occurred in 8.1%. Stomal granulomas were the most frequent late complication and occurred in 16.9%. Airway anomalies were frequently diagnosed in follow-up endoscopic evaluations. Subglottic stenosis was the most frequent airway diagnosis and occurred in 29.4% of the cases followed by laryngomalacia, suprastomal collapse and vocal cord paralysis. Decannulation was achieved in 22.5% of the cases in the three-year period. The main cause for persistent tracheostomy was the need for further treatment of airway pathology. Mortality rate was 18.1% during this period but only 1.3% were directly related to the tracheostomy, the other deaths were a consequence of other comorbidities.
CONCLUSION
Tracheostomies were performed mostly in very small children and comorbidities were very common. Once a tracheostomy was performed in a child in most cases it was not removed before a year. The most common early complication was stoma infection followed by accidental decannulation. The most frequent late complication was granuloma and suprastomal collapse. Airway abnormalities were very frequent in this population and therefore need to be assessed before attempting decannulation.
Topics: Adolescent; Airway Obstruction; Brazil; Child; Child, Preschool; Cohort Studies; Comorbidity; Congenital Abnormalities; Deglutition Disorders; Female; Follow-Up Studies; Granuloma; Humans; Infant; Infant, Newborn; Infections; Male; Respiration, Artificial; Retrospective Studies; Tracheostomy
PubMed: 30193946
DOI: 10.1016/j.anorl.2018.07.007