Cold Instruments, Warm Outcomes: A Decade of Supraglottoplasty in Managing Children with Moderate and Severe Laryngomalacia

Abstract

Objective: The study aims to review the clinical outcomes of supraglottoplasty in moderate and severe laryngomalacia. Methods: This is a retrospective study. Demographic and clinical data of children diagnosed with moderate and severe laryngomalacia who underwent supraglottoplasty between 2012 and 2021 were retrieved from the computerized patient record system of Hospital Sultanah Bahiyah. The surgical procedure of supraglottoplasty was mainly performed with cold instrument, with occasional assistance from a microdebrider. Study outcome includes complete stridor resolution, weaning from tube feeding, and weaning from respiratory support post supraglottoplasty. Results: 124 children were included in the study. Complete stridor resolution was achieved in 64.51% (n=80) 1-month post-surgery and 86.29% (n=107) 3-months post-surgery. Half of the children with tube feeding pre-operatively could be weaned off to oral feeding within 1-month post-surgery. All the children with oral feeding maintained oral feeding post-surgery. All the children with no or low respiratory support (nasal prong oxygen) pre-operatively were able to be weaned down to room air within 1-month post-surgery. Within the group of children with high respiratory support (high-flow nasal cannula, non-invasive ventilation, and endotracheal intubation) pre-operatively, half were weaned down to room air within 1-month post-surgery. None of the children with isolated laryngomalacia required tracheostomy after supraglottoplasty. All laryngomalacia patients who required tracheostomy after supraglottoplasty were associated with either synchronous airway lesions or medical comorbidities. Only 3 cases (2.42%) required revision supraglottoplasty with a maximum of one revision. Conclusions: We conclude that supraglottoplasty contributes to substantial clinical improvement in moderate and severe laryngomalacia. Supraglottoplasty facilitated weaning down of respiratory support and tube feeding in laryngomalacia with respiratory difficulty and feeding intolerance.