Supraglottoplasty and thriving in laryngomalacia. Is there a nexus?

Background: Feeding difficulties and failure to thrive are common findings in severe laryngomalacia.

Aims: To evaluate the outcomes of supraglottoplasty for severe laryngomalacia and its impact on weight progression.

Material and methods: Observational cohort study of paediatric patients with laryngomalacia who underwent supraglottoplasty from 2018 to 2023. Postoperative outcomes, including weight, were evaluated. Children with comorbidities affecting growth were excluded.

Results: Thirty-eight children with severe laryngomalacia underwent supraglottoplasty, with 32 meeting the inclusion criteria; 59.4% were male. The mean age at diagnosis and surgery was 5.8 and 10.5 months, respectively. All cases of respiratory distress were resolved with surgery. In the weight evaluation, 18 patients (56.3%) had a preoperative percentile below 15, of whom ten were below the 5^th percentile. A statistically significant increase was observed between preoperative percentile and consecutive postoperative percentiles at 1, 3 and 12 months. Regarding children with percentile below 15, 75% successfully crossed two percentile lines and 90% of children with failure to thrive managed to rise above the 5^th percentile.

Conclusions and significance: Supraglottoplasty leads to symptomatic improvement and a significant increase in weight percentile in patients with severe laryngomalacia. Growth curves adjusted for gender and age should be an objective measure of supraglottoplasty outcomes.