Indications and results of supraglottoplasty in pediatric patients at Fundación Hospital de la Misericordia in Bogotá, Colombia, a city at 2,600 meters above sea level, years 2017-2018
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Abstract
The most common cause of stridor in pediatric population is laryngomalacia. In papers published at sea level it has been describe an incidence of 70% in patients with stridor. We conducted a cross-sectional study of the cohort of patients that had undergo supraglotoplasty surgery in a fourth level pediatric hospital in a city located at an altitude of 2600 meter between 2017 - 2018.
44 patients were intervened, 43% of whom were diagnosed with type II laryngomalaciA according to Oley´s classification. The surgical indication was due to growing failure in 8 patient, inminent risk to respiratory failure in 17, high risk BRUE in 3 and severe sleep apnea in 20. In 14 patients it was performed an additional procedure as dilatation of subglottic stenosis, amigdalectomy and tongue base resection.
During the intraoperative period there were no complications, during the postoperative a patient with a failed extubation prior to diagnosis required a tracheostomy. Symptoms improved in the immediate postoperative period in most patients. When the patient required intubation prior to the procedure, the average number of days for successful extubation was 1 day. 95% of the patients had a comorbidity.
When analyzing the data obtained we found that patients operated at height for laryngomalacia, have a lower incidence of complete resolution of OSA, but show improvement of symptoms during sleep and minimal oxygen saturation, regardless of the residual hypopnea apnea index. The authors recommend pediatric otolaryngologists to take this difference into account when adressing a patient with laryngomalacia and other comorbidities.
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References
Zoumalan R, Maddalozzo J, Holinger LD. Etiology of Stridor in Infants. 2007;116(5):329–34.
Pereira Valera FC, Tamashiro E, De Araújo MM, Sander HH, Küpper DS. Evaluation of the efficacy of supraglottoplasty in obstructive sleep apnea syndrome associated with severe laryngomalacia. Arch Otolaryngol - Head Neck Surg. 2006;132(5):489–93.
Fauroux B, Pigeot J, Polkey MI, Roger G, Boulé M, Clément A, et al. Chronic stridor caused by laryngomalacia in children: Work of breathing and effects of noninvasive ventilatory assistance. Am J Respir Crit Care Med. 2001;164(10 I):1874–8.
Garritano FG, Carr MM. Characteristics of patients undergoing supraglottoplasty for laryngomalacia. Int J Pediatr Otorhinolaryngol [Internet]. 2014;78(7):1095–100. http://dx.doi.org/10.1016/j.ijporl.2014.04.015
McGovern MC. Causes of apparent life threatening events in infants: a systematic review. Arch Dis Child. 2004;89(11):1043-8
Del Do M, Song SA, Nesbitt NB, Spaw MC, Chang ET, Liming BJ, et al. Supraglottoplasty surgery types 1–3: A practical
classification system for laryngomalacia surgery. Int J Pediatr Otorhinolaryngol. 2018;111:69-74.
Walner DL, Neumann DB, Hamming KK, Miller RP. Supraglottoplasty in Infants: A Staged Approach. Ann Otol
Rhinol Laryngol. 2015;124(10):803-7.
Kay DJ, Goldsmith AJ. Laryngomalacia: a classification system and surgical treatment strategy. Ear Nose Throat J.
;85(5):328–31, 336.
Denoyelle F, Mondain M, Grésillon N, Roger G, Chaudré F, Garabédian EN, et al. Failures and complications of
supraglottoplasty in children. Arch Otolaryngol - Head Neck Surg. 2003;129(10):1077-80.
Weinstein JE, Lawlor CM, Wu EL, Rodriguez KH. International Journal of Pediatric Otorhinolaryngology Utility
of polysomnography in determination of laryngomalacia. Int J Pediatr Otorhinolaryngol. 2017;93:145-9.
Revell SM, Clark WD. International Journal of Pediatric Otorhinolaryngology Late-onset laryngomalacia: A cause of
pediatric obstructive sleep apnea. Int J Pediatr Otorhinolaryngol. 2011;75(2):231-8.
Andersen IG, Holm J-C, Homøe P. Obstructive sleep apnea in children and adolescents with and without obesity. Eur Arch Oto-Rhino-Laryngol Off J Eur Fed Oto-Rhino-Laryngol Soc EUFOS Affil Ger Soc Oto-Rhino-Laryngol - Head Neck Surg.
marzo de 2019;276(3):871-8.
Werner J, Lippert B, Dünne A, Ankermann T, Folz B, Seyberth H. Epiglottopexy for the treatment of severe laryngomalacia. Eur Arch Oto-Rhino-Laryngology. 2002;259(9):459-64.
Chan DK, Truong MT, Koltai PJ. Supraglottoplasty for occult laryngomalacia to improve obstructive sleep apnea syndrome. Arch Otolaryngol Head Neck Surg. 2012;138(1):50-4.
Escher A, Probst R, Gysin C. Management of laryngomalacia in children with congenital syndrome: The role of
supraglottoplasty. J Pediatr Surg. 2015;50(4):519-23.
Zafereo ME, Taylor RJ, Pereira KD. Supraglottoplasty for laryngomalacia with obstructive sleep apnea. The Laryngoscope. 2008;118(10):1873–7.
Lee C-F, Hsu W-C, Lee C-H, Lin M-T, Kang K-T. Treatment outcomes of supraglottoplasty for pediatric obstructive sleep
apnea: A meta-analysis. Int J Pediatr Otorhinolaryngol. 2016;87:18-27.