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Alanzi O, Al-Faleh M, Alsheef H. Features and Associated Comorbidities of Laryngomalacia in Saudi Arabia. Cureus 2023; 15:e47432. [PMID: 38022359 PMCID: PMC10658749 DOI: 10.7759/cureus.47432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
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.
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Affiliation(s)
- Omar Alanzi
- Otorhinolaryngology, King Fahad Specialist Hospital, Dammam, SAU
| | - Moath Al-Faleh
- Otorhinolaryngology, King Fahad Specialist Hospital, Dammam, SAU
| | - Hussain Alsheef
- Pediatric Otorhinolaryngology, Maternity and Children Hospital, Dammam, SAU
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Bhatta S, Gandhi S, Ganesuni D, Ghanpur AD. Long term Follow Up of Severe Laryngomalacia Patients Following CO 2 LASER Supraglottoplasty. Indian J Otolaryngol Head Neck Surg 2022; 74:2472-2476. [PMID: 36452855 PMCID: PMC9702166 DOI: 10.1007/s12070-020-02212-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022] Open
Abstract
Laryngomalacia is the most common cause of stridor. It is believed to be due to delayed development of the supraglottic structures. On the basis of presentation, it has been divided into 3 grades. Management is dependent upon the grades: Mild and moderate laryngomalacia are managed conservatively, while CO2 LASER supraglottoplasty is the surgical management of choice for severe disease. In this study we evaluated the outcomes of supraglottopasty in long term follow up. It was a retrospective study which included patients with severe laryngomalacia who have undergone supraglottoplasty for the dates from July 2013 to July 2018. Weight and height of the patients were taken during the follow up visit after one year and have been compared with that of the normal children of comparable age using the pediatrics growth charts. Follow up was done by telephonic conversation to evaluate the status of other symptoms associated with laryngomalacia. Total of 44 patients were included in the study, 47.7% and 52.3% females and males respectively. Weight for age, weight for height and height for age were normal in 80.9%, 80.9% and 76.1% of patients respectively after supraglottoplasty. Of the patients studied, stridor was resolved in 80.9%, early tiredness during play was resolved in 43.2%, swallowing was normal in 85.7% and there was no aspiration in 90.5%. It can be concluded that patients with severe laryngomalacia improved with respect to airway symptoms, as well as, weight and height on long term follow up after CO2 LASER supraglottoplasty. It is important to evaluate the general status of the patients as a whole to truly assess the success of the surgery in addition to the airway symptoms.
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Affiliation(s)
- Subash Bhatta
- Department of Laryngology, Deenanath Mangeshkar Hospital and Research Centre, Erandwane, Pune, 411004 India
| | - Sachin Gandhi
- Department of Laryngology, Deenanath Mangeshkar Hospital and Research Centre, Erandwane, Pune, 411004 India
| | - Dushyanth Ganesuni
- Department of Laryngology, Deenanath Mangeshkar Hospital and Research Centre, Erandwane, Pune, 411004 India
| | - Asheesh Dora Ghanpur
- Department of Laryngology, Deenanath Mangeshkar Hospital and Research Centre, Erandwane, Pune, 411004 India
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Salloum S, Mahsoun Y, Al-Khatib T, Marzouki H, Zawawi F. Supraglottoplasty in the management of laryngomalacia in children with down syndrome: A systematic review. Int J Pediatr Otorhinolaryngol 2021; 142:110630. [PMID: 33477012 DOI: 10.1016/j.ijporl.2021.110630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/18/2020] [Accepted: 01/12/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Children with Down syndrome (DS) who have Laryngomalacia represent a specific management challenge due to their inherent multiple levels of airway obstruction and hypotonia. Therefore, the purpose of this study is to determine the outcome of supraglottoplasty (SGP) in children with DS. DATA SOURCE A systematic review was performed following the PRISMA guideline. Data were collected from online medical databases- CINAHL, Cochrane Library, Google Scholar, Ovid MEDLINE, Ovid MEDLINE in process, PubMed, and Scopus. REVIEW METHODS all publications that address the outcome of supraglottoplasty in children who are less than 18 years old with Down syndrome prior to December 2018 were collected. The data were collected on different phases: Screening review using search words and controlled vocabularies during the period of November-December 2018, followed by a detailed review of screened articles based on inclusion and exclusion criteria, then a full review that included screening the references of selected articles. RESULTS Nine articles were included in the qualitative analysis. These articles included 231 subjects, out of which 32 children with DS met the inclusion criteria. Twenty patients (62.5%) were considered successfully treated and 12/32 failed including 1/32 (3.1%) mortality in the postoperative period. The duration of follow-up was 12-102 days. All of the patients whose treatment failed had significant comorbidities. CONCLUSION Although the success of SPG in children with DS is less than in otherwise healthy children, it remains an option especially in patients without comorbidities. Preoperative counseling of the families and thorough assessment are necessary to determine candidacy for SPG in children with DS.
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Affiliation(s)
- Sara Salloum
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yasmina Mahsoun
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Talal Al-Khatib
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - HaniZ Marzouki
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faisal Zawawi
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
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Zalzal HG, Davis K, Carr MM, Coutras S. Epiglottopexy with or without aryepiglottic fold division: Comparing outcomes in the treatment of pediatric obstructive sleep apnea. Am J Otolaryngol 2020; 41:102478. [PMID: 32303392 DOI: 10.1016/j.amjoto.2020.102478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the success of epiglottopexy with or without aryepiglottic fold division for treatment of patients with obstructive sleep apnea (OSA) with epiglottic obstruction. STUDY DESIGN Retrospective chart review. SETTING Tertiary care academic hospital. METHODS Children with sleep study proven OSA who underwent epiglottopexy with or without aryepiglottic fold division from January 2013 to June 2017 were included. The epiglottis contributed to airway obstruction in all patients. Pre- and post-operative apnea-hypopnea index (AHI) were compared. Age, sex, body mass index (BMI) z-score and post-operative complications were also evaluated. Success was defined by post-operative AHI < 5.0 with resolution of OSA symptoms or AHI ≤ 1.0 events per hour. RESULTS Twenty-eight children (age 2-17 years) underwent either epiglottopexy with division of aryepiglottic folds (N = 18) or epiglottopexy alone (N = 10). There was no difference in preoperative age, AHI, or BMI between the groups. Post-operative AHI was lower in the group undergoing epiglottopexy alone (AHI 1.50) versus with aryepiglottic fold division (AHI 3.17) (P < 0.05). No difference was found in mean AHI improvement between the two groups. For the entire cohort, success criteria were met by 53.6% of patients for AHI < 5.0 without symptoms and 25.0% of patients for AHI ≤ 1.0, with no difference in surgical success between procedures (P > 0.05). CONCLUSIONS Children undergoing epiglottopexy with division of aryepiglottic folds for laryngeal collapse were as likely to have improved OSA symptoms as children undergoing epiglottopexy alone.
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Sapundzhiev NR, Nikiforova LT, Stoyanov GS, Valkadinov I, Genova P, Platikanov V. Harmonic Shears in the Surgical Treatment of Laryngomalacia. Cureus 2019; 11:e5880. [PMID: 31772850 PMCID: PMC6837271 DOI: 10.7759/cureus.5880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Laryngomalacia (LM) is a condition that is clinically diagnosed in the pediatric period with inspiratory stridor and is caused by a congenital or acquired collapse of laryngeal suprastructures. Endoscopic supraglottoplasty is the modern gold standard surgical treatment for severe or complicated laryngomalacia. Various cold and powered surgical devices have been used to approach the aryepiglottic folds, and their advantages and drawbacks have been widely discussed. The applicability of Ultracision Harmonic shears (Ethicon Inc., NJ, US) for the sake of supraglottoplasty has not been previously advocated in the literature and is the subject of this study. Methods This was a review of the medical records of pediatric patients, with moderate to severe congenital laryngomalacia, who underwent supraglottoplasty with Harmonic at a single institution, from 2013 to 2019. Results A total of six patients underwent bilateral aryepiglottic fold division with the use of Ultracision in the study period (4 male, 2 female; mean age 7+/-9 months, age range 1m-24m). Postoperatively, all of the children were extubated and admitted to the pediatric intensive care unit (PICU) as a precaution measure. There were no early or late complications after the intervention. The postoperative endoscopic picture was evaluated in three patients (two of which for another reason). A stable laryngeal frame with no collapse or excessive scarring was observed. None of the patients required repeat surgery. Conclusion Based on the ease of surgical access, performance, surgical precision, and postoperative results, the use of Harmonic scissors appears to be a safe, practical, affordable, and easily applicable alternative for supraglottoplasty Type 2.
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Affiliation(s)
| | | | - George S Stoyanov
- General and Clinical Pathology, Forensic Medicine and Deontology, Medical University of Varna, Varna, BGR
| | | | - Petya Genova
- Otolaryngology, Medical University of Varna, Varna, BGR
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Camacho M, Dunn B, Torre C, Sasaki J, Gonzales R, Liu SYC, Chan DK, Certal V, Cable BB. Supraglottoplasty for laryngomalacia with obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope 2015; 126:1246-55. [PMID: 26691675 DOI: 10.1002/lary.25827] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine if apnea-hypopnea index (AHI) and lowest oxygen saturation (LSAT) improve following isolated supraglottoplasty for laryngomalacia with obstructive sleep apnea (OSA) in children. STUDY DESIGN Systematic review and meta-analysis. METHODS Nine databases, including PubMed/MEDLINE, were searched through September 30, 2015. RESULTS A total of 517 studies were screened; 57 were reviewed; and 13 met criteria. One hundred thirty-eight patients were included (age range: 1 month-12.6 years). Sixty-four patients had sleep exclusive laryngomalacia, and in these patients: 1) AHI decreased from a mean (M) ± standard deviation (SD) of 14.0 ± 16.5 (95% confidence interval [CI] 10.0, 18.0) to 3.3 ± 4.0 (95% CI 2.4, 4.4) events/hour (relative reduction: 76.4% [95% CI 53.6, 106.4]); 2) LSAT improved from a M ± SD of 84.8 ± 8.4% (95% CI 82.8, 86.8) to 87.6 ± 4.4% (95% CI 86.6, 88.8); 3) standardized mean differences (SMD) demonstrated a small effect for LSAT and a large effect for AHI; and 4) cure (AHI < 1 event/hour) was 10.5% (19 patients with individual data). Seventy-four patients had congenital laryngomalacia, and in these patients: 1) AHI decreased from a M ± SD of 20.4 ± 23.9 (95% CI 12.8, 28.0) to 4.0 ± 4.5 (95% CI 2.6, 5.4) events/hour (relative reduction: 80.4% [95% CI 46.6, 107.4]); 2) LSAT improved from a M ± SD of 74.5 ± 11.9% (95% CI 70.9, 78.1) to 88.4 ± 6.6% (95% CI 86.4, 90.4); 3) SMD demonstrated a large effect for both AHI and LSAT; and 4) cure was 26.5% (38 patients with individual data). CONCLUSION Supraglottoplasty has improved AHI and LSAT in children with OSA and either sleep exclusive laryngomalacia or congenital laryngomalacia; however, the majority of them are not cured. Laryngoscope, 126:1246-1255, 2016.
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Affiliation(s)
- Macario Camacho
- Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii.,Department of Psychiatry and Behavioral Sciences, Sleep Medicine Division, Stanford Hospital and Clinics, Stanford Hospital and Clinics, Stanford, California, U.S.A
| | - Brandyn Dunn
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Carlos Torre
- Department of Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery, Stanford Hospital and Clinics, Stanford, California, U.S.A
| | - Jodie Sasaki
- John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
| | - Raymond Gonzales
- Department of Otorhinolaryngology/Sleep Medicine Centre-Hospital CUF, University of Porto, Porto, Portugal
| | - Stanley Yung-Chuan Liu
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of California San Francisco, San Francisco, California, U.S.A
| | - Dylan K Chan
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, U.S.A
| | - Victor Certal
- CINTESIS-Centre for Research in Health Technologies and Information Systems, University of Porto, Porto, Portugal
| | - Benjamin B Cable
- Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, Tripler Army Medical Center, Honolulu, Hawaii
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