DISCOORDINATE PHARYNGOLARYNGOMALACIA

In cases of severe laryngomalacia, laser division of the aryepiglottic folds (AEFs) or endoscopic supraglottoplasty may be an ineffective so lution. Failure of this technique is rare and the reasons for failure are not well established. The purpose of this study was to describe th ose cases of laryngomalacia in which endoscopic treatment did not reve rse the clinical situation. We introduce the concept of discoordinate pharyngolaryngomalacia (DPLM). DPLM was defined as severe laryngomalac ia with complete supraglottic collapse during inspiration, without sho rtened AEFs or redundant mucosa, and with associated pharyngomalacia, Twenty-seven of 82 children with severe laryngomalacia presented a DPL M. Endoscopic treatment was performed in 16 children and the surgical procedure was inadequate to reverse the clinical problem in these pati ents. In 10 children correction of additional sites of obstruction was required (uvulopharyngopalatoplasty, surgery of choanal atresia, aort opexy). Tracheostomy was necessary in 13 children. Bi-level positive a irway pressure (BiPAP) was used successfully in 2 children and tracheo tomy was avoided. Treatment still needs to be better defined. (C) 1997 Elsevier Science Ireland Ltd.