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Mills JF, Monaghan NP, Nguyen SA, Nguyen CL, Clemmens CS, Carroll WW, Pecha PP, White DR. Characteristics and outcomes of interventions for pediatric laryngomalacia: A systematic review with meta-analysis. Int J Pediatr Otorhinolaryngol 2024; 178:111896. [PMID: 38364547 DOI: 10.1016/j.ijporl.2024.111896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/07/2024] [Accepted: 02/11/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To analyze characteristics of children treated for laryngomalacia to determine predictive factors and provide an updated meta-analysis on outcomes. METHODS A systematic review was conducted according to PRISMA guidelines from inception to May 2, 2023, using CINAHL, PubMed, and Scopus databases. Study screening, data extraction, quality rating, and risk of bias assessment were performed by 2 independent reviewers. Data were meta-analyzed using fixed-/random-effects model to derive continuous measures (mean), proportions (%), and mean difference (Δ) with 95% confidence interval (CI). RESULTS 100 articles were identified with information on outcomes of pediatric patients with laryngomalacia (N = 18,317). The mean age was 10.6 months (range: 0 to 252, 95%CI: 9.6 to 11.6, p = 0.00) with a 1.4:1 male to female ratio. Many patients presented with stridor (87.9%, 95% CI: 69.8 to 98.4), and the most common comorbidity at time of diagnosis was gastroesophageal reflux disease (48.8%, 95%CI: 40.9 to 56.8). Based on the patient population included in our analysis, 86.1% received supraglottoplasty (95% CI: 78.7 to 92.1). A total of 73.6% (95% CI: 65.5 to 81.0) had reported complete resolution of symptoms. For patients with a concurrent diagnosis of sleep disordered breathing receiving supraglottoplasty, the apnea-hypopnea index improved with a mean difference of -10.0 (95%CI: 15.6 to -4.5) events per hour post-treatment. CONCLUSIONS Laryngomalacia continues to be a common problem in the pediatric population. Supraglottoplasty remains an effective treatment option leading to symptomatic improvement in many cases. For those with concurrent sleep disordered breathing, supraglottoplasty lowers the apnea-hypopnea index.
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Affiliation(s)
- John F Mills
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA; Albany Medical College, 47 New Scotland Avenue, Albany, NY, 12208, USA
| | - Neil P Monaghan
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA
| | - Shaun A Nguyen
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA.
| | | | - Clarice S Clemmens
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA
| | - William W Carroll
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA
| | - Phayvanh P Pecha
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA
| | - David R White
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, 135 Rutledge Avenue, Charleston, SC, 29425, USA
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Drummond RL, Padoin RCPK, Salgueiro BD, Lubianca Neto JF. Efficacy and predictors of success on laryngomalacia surgery: experience from a tertiary pediatric care center in Brazil. Braz J Otorhinolaryngol 2023; 89:101315. [PMID: 37716096 PMCID: PMC10509652 DOI: 10.1016/j.bjorl.2023.101315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 09/18/2023] Open
Abstract
OBJECTIVES Laryngomalacia is the most common congenital cause of stridor; the natural history of the disease runs through to complete resolution by the age of two. Severe cases are characterized by cyanosis, hypoxia, apnea, furcular and/or subcostal retractions, aspirations, pulmonary hypertension, and failure to thrive and must undergo surgery. This study aimed to evaluate the success rates of supraglottoplasty in our hospital and evaluate the predictive factors for surgical success. METHODS Cohort study, prospectively planned. 75 patients undergoing endoscopic surgery from July 2007 to July 2016 were analyzed at the Santo Antônio Children's Hospital. The primary outcome was percentage of surgical success, defined as the absence of respiratory symptoms or presence of a mild stridor without retractions on the first post-operative month (late success). The secondary outcomes were the early surgical success (absence of respiratory symptoms or presence of a mild stridor without retractions on the first post-operative day). RESULTS 39 (58.2%) were male, with an average of 4.9 months. Surgical success on the first day was 80.6% (n=54). At the end of the 1st month, surgical success was 88.6%, considering only those who completed assessment. Twenty-one (34%) presented comorbidities. Presence of comorbidities, pharyngomalacia and GERD were associated with a worse result on the 1st postoperative day, whereas, at the end of the first month, presence of comorbidities, concomitant injuries (tracheo and bronchomalacia) and pharyngomalacia were the predictive variables of surgery failure. CONCLUSION Supraglottoplasty has high rates of efficacy and low morbidity. The presence of comorbidities and pharyngomalacia has shown association with a worse early and late surgical outcome. Synchronous airway lesions predict a worse surgical result at the end of the first month. GERD was associated with obstructive symptomatology only in the 1st post-operative day. LEVEL OF EVIDENCE Level 3 of evidence, according to the "The Oxford 2011 Levels of Evidence" from Oxford Centre for Evidence-Based Medicine.
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Affiliation(s)
- Renata Loss Drummond
- Santa Casa de Misericórdia de Porto Alegre (UFCSPA), Serviço de Otorrinolaringologia e do Programa de Residência Médica em Otorrinolaringologia, Porto Alegre, RS, Brazil; Hospital da Criança Santo Antônio, Serviço de Otorrinolaringologia Pediátrica, Programa de Fellowship em Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil
| | - Rita Carolina Pozzer Krumenauer Padoin
- Santa Casa de Misericórdia de Porto Alegre (UFCSPA), Serviço de Otorrinolaringologia e do Programa de Residência Médica em Otorrinolaringologia, Porto Alegre, RS, Brazil; Hospital da Criança Santo Antônio, Serviço de Otorrinolaringologia Pediátrica, Programa de Fellowship em Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil
| | - Bárbara Duarte Salgueiro
- Hospital da Criança Santo Antônio, Serviço de Otorrinolaringologia Pediátrica, Programa de Fellowship em Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil.
| | - José Faibes Lubianca Neto
- Santa Casa de Misericórdia de Porto Alegre (UFCSPA), Serviço de Otorrinolaringologia e do Programa de Residência Médica em Otorrinolaringologia, Porto Alegre, RS, Brazil; Hospital da Criança Santo Antônio, Serviço de Otorrinolaringologia Pediátrica, Programa de Fellowship em Otorrinolaringologia Pediátrica, Porto Alegre, RS, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Disciplina de Otorrinolaringologia (ORL) e Programa de Pós-Graduação em Pediatria, Porto Alegre, RS, Brazil
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Huang YC, Cheng YL, Su WL, Lan CC, Wu YK, Yang MC. Co-existing obstructive sleep apnea reduces Nuss surgery efficacy in pectus excavatum. PLoS One 2022; 17:e0277494. [PMID: 36367884 PMCID: PMC9651565 DOI: 10.1371/journal.pone.0277494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022] Open
Abstract
Nuss surgery is effective in correcting pectus excavatum (PE), with a recurrence rate of 1.2–27%. Re-do surgery is successful but still has a 6% failure rate. Patients with obstructive sleep apnea (OSA) experience repetitive PE-associated sternal depression during sleep. As the prevalence of OSA among PE patients is higher than the average, co-existing OSA in PE patients might negatively affect the efficacy of Nuss surgery. This study aimed to evaluate the impact of co-existing OSA on Nuss surgery in patients with PE. In total, 20 adult patients with PE only and 9 patients with PE and OSA were analyzed. Polysomnography was performed before Nuss surgery to evaluate OSA. Sternovertebral distance (SVD) and radiographic Haller index (RHI) were recorded before surgery and at 3, 6, and 24 months postoperatively. The results showed that percentage changes in SVD in patients with PE only at 3, 6, and 24 months postoperatively were significantly increased compared with those in the patients with PE and OSA (31.1% vs. 14.1% at 3 months; 37.5% vs. 21.4% at 6 months; 42.5% vs. 19.2% at 24 months). Meanwhile, percentage changes in RHI were significantly lower in patients with PE alone than in the patients with PE and OSA (-22.9% vs. -9.3% at 3 months; -27.9% vs. -18.7% at 6 months; -30.6% vs. -16.7% at 24 months). This study showed that co-existing OSA might reduce the efficacy of Nuss surgery for patients with PE. We recommend that patients with PE should be evaluated and treated for OSA before surgery to prevent surgical failure after bar removal.
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Affiliation(s)
- Yi-Chih Huang
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yeung-Leung Cheng
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Division of Chest Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Wen-Lin Su
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chou-Chin Lan
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yao-Kuang Wu
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Mei-Chen Yang
- Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- * E-mail:
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Cialente F, Meucci D, Tropiano ML, Salvati A, Torsello M, Savignoni F, Landolfo F, Dotta A, Trozzi M. Changes in Breathing Patterns after Surgery in Severe Laryngomalacia. CHILDREN 2021; 8:children8121120. [PMID: 34943316 PMCID: PMC8700109 DOI: 10.3390/children8121120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/29/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022]
Abstract
Background: Most of the studies regarding the surgical treatment of severe laryngomalacia (LM) have been aimed at describing the efficacy of the treatment in terms of improvement of clinical symptoms or anatomical findings. There are no studies specifically aimed at analyzing the changes in breathing patterns following surgical treatment for severe LM. Objective: To review the breathing pattern changes before and after corrective surgery in infants with severe LM. Study design: A series of retrospective cases at a tertiary referral children’s hospital. Methods: Retrospective chart review of 81 infants who underwent supra-glottoplasty (SGP) for severe laryngomalacia between 2011 and 2020 at Bambino Gesù Children’s Hospital of Rome, Italy. Among the patients, 47 (58%) were male and 34 (42%) were female. Twenty-one patients (26%) had one or more comorbidities condition. The data collected included age, symptoms, a polysomnography/pulse oximetry study, growth rate, the findings from flexible endoscopy, pre- and post-supra-glottoplasty (SGP) pulmonary function tests (PFTs) and, when indicated, 24 h pH-metry. Breathing patterns were studied during restful, normal sleep, using an ultrasonic flow-meter (Exhalyzer, Viasys) which measured: Tidal Volume (Vt), Respiratory Rate (RR), time to peak expiratory flow/expiratory time ratio (tPTEF/Te, an index of the patency of the lower airways) and mean expiratory/mean inspiratory flow ratio (MEF/MIF, an index of the patency of the upper airways) evaluated before surgical procedure (T1) and 3–6 weeks after (T2). Pre- and post-operative mean data were calculated and comparisons made with a Student T-test. Results: The surgical procedure was well tolerated by all infants and no intraoperative or post-operatory long-term complications were noted. In T1, breathing patterns were characterized by low tidal volume and high tPTEF/Te and MEF/MIF ratios, suggesting a severe reduction in the patency of the upper airways in all patients. After surgery (T2), all the previously mentioned variables significantly improved, reaching normal values for the child’s age. Conclusions: Supra-glottoplasty, as already described in several studies, is a safe and efficient procedure to treat severe laryngomalacia during infancy. The improvement in breathing patterns after surgery was reliably confirmed by a lung function test in our study, which showed the diagnostic value of testing respiratory functionality in the laryngomalacia and comparing them to clinical and endoscopic data. Moreover, considering the results obtained, we also propose the use of this available, dependable test to verify its therapeutic effects (post-surgery) and to monitor future respiratory development in these infants. Moreover, we believe that further studies will provide detailed grading guidelines for gravity of the LM, based on these functional lung tests.
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Affiliation(s)
- Fabrizio Cialente
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (D.M.); (M.L.T.); (A.S.); (M.T.); (M.T.)
- Correspondence:
| | - Duino Meucci
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (D.M.); (M.L.T.); (A.S.); (M.T.); (M.T.)
| | - Maria Luisa Tropiano
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (D.M.); (M.L.T.); (A.S.); (M.T.); (M.T.)
| | - Antonio Salvati
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (D.M.); (M.L.T.); (A.S.); (M.T.); (M.T.)
| | - Miriam Torsello
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (D.M.); (M.L.T.); (A.S.); (M.T.); (M.T.)
| | - Ferdinando Savignoni
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.S.); (F.L.); (A.D.)
| | - Francesca Landolfo
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.S.); (F.L.); (A.D.)
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Department of Neonatology, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (F.S.); (F.L.); (A.D.)
| | - Marilena Trozzi
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (D.M.); (M.L.T.); (A.S.); (M.T.); (M.T.)
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Cheng YL, Tzeng IS, Yang MC. Increased prevalence of obstructive sleep apnea in patients with pectus excavatum: A pilot study. Tzu Chi Med J 2018; 30:233-237. [PMID: 30305787 PMCID: PMC6172901 DOI: 10.4103/tcmj.tcmj_115_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: Laryngomalacia is the most common congenital laryngeal anomaly and is associated with pectus excavatum (PE). Patients with laryngomalacia and patients with obstructive sleep apnea (OSA) both experience upper airway obstruction, and patients with laryngomalacia had been found to have a higher prevalence of PE. However, no studies have established the prevalence of OSA in patients with PE. We conducted this pilot study to evaluate the prevalence of OSA in patients with PE. Materials and Methods: A total of 42 patients ≥20 years old with PE who were admitted for Nuss surgery to correct PE in Taipei Tzu Chi Hospital between October 2015 and September 2016 were invited to participate in the study; 31 of the 42 patients agreed. All 31 patients completed an Epworth sleepiness scale questionnaire to evaluate excessive daytime sleepiness (EDS) and underwent overnight polysomnography to evaluate OSA before Nuss surgery. Results: The prevalence of snoring in the study participants was 100%. Ten of 31 patients (32.3%) reported EDS. The overall prevalence of OSA with an apnea/hypopnea index ≥5/h was 25.8%, and all patients with OSA were men. Conclusions: The prevalence of OSA in patients with PE seemed to be higher than that previously reported in the general population, implying that OSA might be a potential etiology or, at least, an aggravating factor for the development or progression of PE or might be responsible for the postoperative recurrence of PE in some patients. Further studies are needed to clarify this relationship.
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Affiliation(s)
- Yeung-Leung Cheng
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
| | - Mei-Chen Yang
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan
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Cheng YL, Lan CC, Wu YK, Su WL, Yang MC. Poorer sleep quality among adult patients with pectus excavatum in Taiwan: A pilot study. J Thorac Cardiovasc Surg 2018; 157:769-780.e1. [PMID: 30195589 DOI: 10.1016/j.jtcvs.2018.07.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 06/29/2018] [Accepted: 07/14/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Patients with pectus excavatum have a poorer quality of life than the general population. Sleep quality is a critical component of quality of life. This pilot study compared the sleep quality of adult patients with pectus excavatum with that of the general population in Taiwan. METHODS Participants comprised 30 healthy adults, 21 adult outpatients with pectus excavatum, and 33 adults with pectus excavatum receiving Nuss surgery. The Pittsburgh Sleep Quality Index measured subjective sleep quality; the Visual Analog Scale for Pain, Brief Symptom Rating Scale-5, Beck Depression Inventory II, and 36-Item Short Form Survey measured quality of life; and the Epworth Sleepiness Scale measured excessive daytime sleepiness. Outcome measurements were obtained at baseline for all groups and 6 months after Nuss surgery for inpatients. RESULTS Patients with pectus excavatum had poorer sleep quality and worse quality of life than controls. Poorer sleep quality was not related to the severity of pectus excavatum per se, but to psychologic issues (beta = 0.18, P < .001 in multiple linear regression analysis). Measurement time had no effect on sleep quality (beta = 0.31, P = .594 for outpatient group; beta = 0.27, P = .665 for inpatients). Sleep quality of patients with pectus excavatum improved after Nuss surgery (Pittsburgh Sleep Quality Index: 4 vs 7, P = .002). CONCLUSIONS Our findings suggested an association between poor sleep quality and pectus excavatum; thus, sleep quality should be evaluated before and after the Nuss procedure.
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Affiliation(s)
- Yeung-Leung Cheng
- Division of Thoracic Surgery, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Chou-Chin Lan
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Yao-Kuang Wu
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Wen-Lin Su
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Mei-Chen Yang
- School of Medicine, Tzu Chi University, Hualien, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
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Del Do M, Song SA, Nesbitt NB, Spaw MC, Chang ET, Liming BJ, Cable BB, Camacho M. Supraglottoplasty surgery types 1-3: A practical classification system for laryngomalacia surgery. Int J Pediatr Otorhinolaryngol 2018; 111:69-74. [PMID: 29958617 DOI: 10.1016/j.ijporl.2018.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE The objective of this study is to review the published literature on supraglottoplasty techniques for correcting laryngomalacia, and to subsequently provide a standardized classification system. METHODS Three authors independently and systematically searched Pubmed/MEDLINE and six additional databases for all studies that included descriptions of supraglottoplasty techniques for correcting laryngomalacia. Sub-sites operated on and specific technique descriptions were reviewed, cataloged and subsequently categorized. This data was then used to develop a new classification system. RESULTS 231 articles were identified, downloaded and reviewed in full text. 53 articles with 1669 patients from the included articles described in detail the supraglottoplasty procedure. 84 articles with 5731 patients had to be excluded secondary to not providing detail about the supraglottoplasty procedure. The resultant data identifies the need for a more standardized reporting of the supraglottoplasty procedure in order to more accurately evaluate technique specific outcomes. Currently 77% of the patients in the literature cannot be assessed for outcomes as they did not describe the details for the procedures. Eight variations of supraglottoplasty and four variations of epiglottis surgery were described. Based on the literature, we consolidated the surgery into the following types: Type 1: Debulking of arytenoids, Type 2: Division of aryepiglottic folds, Type 3: Epiglottis surgery. CONCLUSION This descriptive review identified 53 articles with 1669 patients from the included articles detailing multiple variations of supraglottoplasty techniques. The new classification supplements a previously established system describing laryngomalacia, and simplifies the supraglottoplasty into three descriptive and logical types of categories. Our classification system would give surgeons a universal language to describe the supraglottoplasty performed, which could improve reporting of techniques, and facilitate future communication and research.
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Affiliation(s)
- Michael Del Do
- Otolaryngology-Head and Neck Surgery, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA.
| | - Sungjin A Song
- Otolaryngology-Head and Neck Surgery, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA
| | - Nicholas B Nesbitt
- School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Mark C Spaw
- Otolaryngology-Head and Neck Surgery, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA
| | - Edward T Chang
- Otolaryngology-Head and Neck Surgery, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA
| | - Bryan J Liming
- Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA.
| | - Benjamin B Cable
- Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA
| | - Macario Camacho
- Otolaryngology-Head and Neck Surgery, Division of Sleep Surgery and Medicine, 1 Jarrett White Road, Tripler Army Medical Center, HI, 96859, USA.
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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: 52] [Impact Index Per Article: 5.8] [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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Skerrett SC, McClaran JK, Fox PR, Palma D. Clinical Features and Outcome of Dogs with Epiglottic Retroversion With or Without Surgical Treatment: 24 Cases. J Vet Intern Med 2015; 29:1611-8. [PMID: 26449284 PMCID: PMC4895681 DOI: 10.1111/jvim.13628] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 08/09/2015] [Accepted: 08/26/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Published information describing the clinical features and outcome for dogs with epiglottic retroversion (ER) is limited. HYPOTHESIS/OBJECTIVES To describe clinical features, comorbidities, outcome of surgical versus medical treatment and long-term follow-up for dogs with ER. We hypothesized that dogs with ER would have upper airway comorbidities and that surgical management (epiglottopexy or subtotal epiglottectomy) would improve long-term outcome compared to medical management alone. ANIMALS Twenty-four client-owned dogs. METHODS Retrospective review of medical records to identify dogs with ER that underwent surgical or medical management of ER. RESULTS Dogs with ER commonly were middle-aged to older, small breed, spayed females with body condition score (BCS) ≥6/9. Stridor and dyspnea were the most common presenting signs. Concurrent or historical upper airway disorders were documented in 79.1% of cases. At last evaluation, 52.6% of dogs that underwent surgical management, and 60% of dogs that received medical management alone, had decreased severity of presenting clinical signs. In dogs that underwent surgical management for ER, the incidence of respiratory crisis decreased from 62.5% before surgery to 25% after surgical treatment. The overall calculated Kaplan-Meier median survival time was 875 days. CONCLUSION AND CLINICAL IMPORTANCE Our study indicated that a long-term survival of at least 2 years can be expected in dogs diagnosed with epiglottic retroversion. The necessity of surgical management cannot be determined based on this data, but dogs with no concurrent upper airway disorders may benefit from a permanent epiglottopexy to alleviate negative inspiratory pressures.
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Affiliation(s)
- S C Skerrett
- Surgery Department, Animal Medical Center, New York, NY
| | - J K McClaran
- Surgery Department, Animal Medical Center, New York, NY
| | - P R Fox
- Caspary Research Institute and Education Outreach Director, Animal Medical Center, New York, NY
| | - D Palma
- Internal Medicine Department, Animal Medical Center, New York, NY
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10
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Pinto JA, Wambier H, Mizoguchi EI, Gomes LM, Kohler R, Ribeiro RC. Surgical treatment of severe laryngomalacia: a retrospective study of 11 case. Braz J Otorhinolaryngol 2014; 79:564-8. [PMID: 24141669 PMCID: PMC9442379 DOI: 10.5935/1808-8694.20130101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 06/14/2013] [Indexed: 11/20/2022] Open
Abstract
Laryngomalacia is the most frequent congenital abnormality of the larynx, accounting for approximately 60-75% of congenital stridor cases. Despite its benign and self-limited aspects, 10% of cases require intervention. Currently, supraglottoplasty is considered the standard treatment of severe laryngomalacia. Objective To describe the experience of the authors in the surgical treatment of patients with severe laryngomalacia. Methodology: A retrospective study. Method The medical records of 11 consecutive cases of severe laryngomalacia who underwent surgical treatment between 2003 and 2012 were analyzed for age, gender, symptoms, associated diseases, surgical technique employed, extubation time, surgical complications, length of hospital stay and clinical outcome. Results Of the 11 cases of severe laryngomalacia, six patients (54.5%) were operated with the use of CO2 laser and five patients (45.5%) were submitted to the cold technique. Only 1 patient (9.1%) required surgical reintervention. There were no cases of surgical complications. All patients had clinical improvement. Conclusion Supraglottoplasty proved to be effective and safe in the treatment of severe laryngomalacia.
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Affiliation(s)
- José Antonio Pinto
- Núcleo de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço de São Paulo
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11
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Lubianca Neto JF, Drummond RL, Oppermann LP, Hermes FS, Krumenauer RCP. Laryngomalacia surgery: a series from a tertiary pediatric hospital. Braz J Otorhinolaryngol 2012. [PMID: 23306576 PMCID: PMC9446370 DOI: 10.5935/1808-8694.20120041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Laryngomalacia is the condition responsible for 75% of the cases of stridor in children aged up to 30 months, in which there is supraglottic collapse during inhalation. Inspiratory stridor is a characteristic telltale. As many as 20% of the patients are severely affected and require surgery. Supraglottoplasty is the procedure of choice and the presence of comorbidities is the most relevant prognostic factor for surgery success. Objective To describe a series in a tertiary pediatric hospital, its success rates, and surgery prognostic factors. Method This retrospective cohort study enrolled 20 patients submitted to supraglottoplasty between July 2007 and May 2011. Results Thirteen (65%) patients were males; mean age at the time of the procedure was 6.32 months. Endoscopic examination showed that 12 subjects had combined forms of laryngomalacia, 40% had associated pharyngomalacia, and three also had tracheomalacia. Thirteen subjects had isolated laryngomalacia and seven had gastroesophageal reflux disease. Fifteen (75%) patients underwent aryepiglottic fold resection. After the procedure, eleven patients were asymptomatic and two required tracheostomy. Presence of comorbidities was the strongest predictor of unfavorable postoperative outcome (p = 0.034). Conclusion Supraglottoplasty is a safe therapeutical procedure for select patients with laryngomalacia.
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12
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Day KE, Discolo CM, Meier JD, Wolf BJ, Halstead LA, White DR. Risk factors for supraglottoplasty failure. Otolaryngol Head Neck Surg 2011; 146:298-301. [PMID: 21987654 DOI: 10.1177/0194599811425652] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review outcomes after supraglottoplasty for laryngomalacia and identify risk factors for supraglottoplasty failure. STUDY DESIGN Case series with chart review. SETTING Tertiary care children's hospital. SUBJECTS AND METHODS Retrospective case series evaluating patient outcomes after supraglottoplasty at an academic medical center between 2004 and 2010. Surgical failure was defined as need for revision surgery, tracheostomy tube placement, or gastrostomy tube insertion. Multivariable logistic regression was performed to identify risk factors for failure. RESULTS The authors identified 95 children who underwent supraglottoplasty. After excluding patients with inadequate follow-up data, 74 patients were included. On the basis of chart review, 12 (16%) of those patients were defined as failures according to the criteria above. Age, history of prematurity (<34 weeks' gestational age), weight, growth curve percentile, neurologic/developmental problems, genetic syndrome, cardiac abnormality, synchronous airway lesions, and surgical technique were considered in risk factor analysis. Multivariable logistic regression was performed, revealing history of prematurity to be the only independent risk factor for failure (odds ratio = 4.85; 95% confidence interval, 1.07-22.1; P = .041). CONCLUSIONS Outcomes after supraglottoplasty were comparable to previous reports in the literature. History of prematurity should be considered a risk factor for surgical failure.
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Affiliation(s)
- Kristine E Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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13
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Flanders JA, Thompson MS. Dyspnea caused by epiglottic retroversion in two dogs. J Am Vet Med Assoc 2009; 235:1330-5. [DOI: 10.2460/javma.235.11.1330] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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