Article

Improved growth curve measurements after supraglottoplasty.

Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
The Laryngoscope (Impact Factor: 2.03). 07/2011; 121(7):1574-7. DOI: 10.1002/lary.21865
Source: PubMed

ABSTRACT To evaluate changes in growth curve measurements after supraglottoplasty and compare these patterns to patients with laryngomalacia treated conservatively.
Retrospective case-control study.
Children treated surgically for laryngomalacia were compared to control groups of patients who underwent observation or medical treatment only. Body weight the day of surgery and on follow-up visits was plotted on a standardized growth curve and the z-score calculated.
A total of 15 patients were included that were observed (group 1), 71 patients that were treated with medical therapy only (group 2), and 29 patients that underwent surgery (group 3). The average z-score at the time of surgery was significantly worse in group 3 (-0.854 ± 1.080), compared to the z-score at the time of diagnosis in group 1 (-0.086 ± 0.834), and the time when antireflux therapy was initiated in group 2 (-0.120 ± 0.979). Within 3 months from surgery, significant improvement on the growth curve was seen in group 3 (P = .009). After 12 months, all three groups approached the mean on the growth curve.
In this series, patients with severe laryngomalacia who warranted surgery presented with significantly lower percentile weight on a standardized growth curve than patients who required only medical or conservative treatment. Substantial improvement in growth curve percentile was seen in the immediate months following supraglottoplasty. Long-term follow-up after supraglottoplasty shows that infants return to a mean weight on the growth curve.

Full-text

Available from: Jeremy Meier, Jun 02, 2015
0 Followers
 · 
235 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Laryngomalacia is the most common cause of stridor in infants. Stridor results from upper airway obstruction caused by collapse of supraglottic tissue into the airway. Most cases of laryngomalacia are mild and self-resolve, but severe symptoms require investigation and intervention. There is a strong association with gastroesophageal reflux disease in patients with laryngomalacia, and thus medical treatment with antireflux medications may be indicated. Supraglottoplasty is the preferred surgical treatment of laryngomalacia, reserved only for severe cases. Proper identification of those patients who require medical and surgical intervention is key to providing treatment with successful outcomes.
    Pediatric Clinics of North America 08/2013; 60(4):893-902. DOI:10.1016/j.pcl.2013.04.013 · 2.20 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective. To compare the growth of infants with moderate to severe laryngomalacia who underwent supraglottoplasty to the growth of those treated with medical therapy alone. Study Design. Case-control study of patients treated between 2008 and 2013. Setting. Tertiary care pediatric otolaryngology practice. Subjects and Methods. Fifty-one infants newly diagnosed with moderate to severe congenital laryngomalacia. Seventeen infants underwent supraglottoplasty and 34 matched controls had medical management, which included acid suppression therapy, speech and swallowing therapy, and/or high-calorie formula. The primary outcome measure was weight percentile recorded at the second clinic visit and at the last available follow-up. The secondary outcomes were the need for primary or revision supraglottoplasty, tracheostomy or gastrostromy, or the development of or persistence of failure to thrive. Results. There was no difference in the mean weight percentile between the surgical and nonsurgical groups at the time of last follow-up (P = .89). The mean change in weight percentile during the study period was 32% (95% CI, 15%-48%) in the supraglottoplasty group and 31% (95% CI, 22%-40%) in the medical group (P = .97). Five of 5 (100%) patients with failure to thrive managed surgically and 10 of 10 (100%) managed medically were above the fifth percentile at the end of the follow-up period. One (3%) patient in the medical management group required tracheostomy and gastrostomy tube placement. Conclusions. Medical management and close observation of infants with moderate to severe congenital laryngomalacia may be a viable alternative to supraglottoplasty in appropriately selected infants.
    Otolaryngology Head and Neck Surgery 06/2014; 151(1 Suppl). DOI:10.1177/0194599814541921 · 1.72 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Protocols for the treatment of Robin sequence (RS) consider the presence of laryngomalacia as a contraindication to mandibular distraction osteogenesis (MDO). The authors report their institutional experience of MDO applied to infants with RS and associated laryngomalacia. An 8-year (2005-2013) retrospective review of all infants with RS and laryngomalacia who underwent MDO at a tertiary care children's hospital was performed. Patients were excluded if they possessed an airway anomaly other than laryngomalacia. Laryngomalacia was identified on laryngoscopy before MDO. Laser supraglottoplasty was performed at the discretion of the otolaryngologist. Recorded variables included preoperative and postoperative AHI, syndromic diagnosis or genetic anomalies, cardiac, central nervous system (CNS), and gastrointestinal (GI) abnormalities. The primary outcomes measured were avoidance or decannulation of tracheostomy and decrease in postoperative AHI. Eleven infants met inclusion criteria. Mean follow-up was 28 months. 18.2% of patients had a syndromic diagnosis, 36.4% cardiac, 9.1% CNS, and 72.7% GI abnormalities. Mean preoperative AHI was 46.1 ± 31.8 and mean postoperative AHI was 4.1 ± 3.0 (P = 0.002). All patients without a tracheostomy before intervention avoided tracheostomy after MDO. One patient had a tracheostomy before MDO and was subsequently decannulated. One patient died 1 year after MDO due to complex congenital heart disease. Infants with RS and laryngomalacia can be successfully treated with MDO to relieve upper airway obstruction. Close cooperation with a pediatric otolaryngologist and treatment of laryngomalacia can significantly enhance tracheostomy avoidance in infants with Robin sequence.
    The Journal of craniofacial surgery 04/2015; 26(3). DOI:10.1097/SCS.0000000000001546 · 0.68 Impact Factor