LARYNGOMALACIA - THE SEARCH FOR THE 2ND LESION

Objectives: To determine the necessity of rigid endoscopy in the diagn osis and management of laryngomalacia and its associated synchronous a irway lesions (SALs), to analyze the incidence of SALs associated with laryngomalacia and their significance, and to determine the need for epiglottoplasty in management of laryngomalacia. Design: Retrospective medical chart review. Setting: Tertiary care children's hospital. Pat ients: Two hundred thirty-three patients with a primary diagnosis of l aryngomalacia on flexible fiberoptic laryngoscopy treated at the Child ren's National Medical Center, Washington, DC, from January 1, 1984, t o June 30, 1994. Interventions: Evaluation and treatment of laryngomal acia acid associated SAL by flexible fiberoptic laryngoscopy, radiogra phic studies, rigid endoscopy, and other surgical procedures. Main Out come Measures: Resolution of airway symptoms from laryngomalacia and a ssociated SAL. Results: Ninety patients (38.6%) underwent rigid endosc opy, and 12 patients (5.2%) required epiglottoplasty. Synchronous airw ay lesions were discovered in 44 patients (18.9%). Eleven patients (4. 7%) had SALs that were considered clinically significant; nine (3.9%) of these required surgical intervention. Conclusions: Rigid endoscopy in evaluation of an infant with laryngomalacia is rarely necessary. Cl inically significant SALs requiring surgical intervention are uncommon . Surgical intervention for laryngomalacia also is rarely necessary.