Management of congenital laryngeal malformations

Congenital malformations of the larynx are relatively rare but may be life- threatening. The most common causes include laryngomalacia, vocal cord para lysis, and subglottic stenosis. The last 20 years has seen major advances i n the field of surgical correction of such anomalies also serving to reduce the number of tracheotomies in children and the inherent dangers they pose . Success rates for the most popular surgical procedures have been favorabl e. These include supraglottoplasty for cases of severe laryngomalacia, in w hich relief of respiratory symptoms has been shown to occur in excess of 80 % of cases. Complication rate is low, although postoperative death has been reported. Failure usually occurs in patients with concomitant airway abnor malities including pharyngomalacia. Vocal cord lateralization for vocal cor d paralysis with airway compromise is achieved by means of arytenoidopexy o r arytenoidectomy, using the lateral approach. Arytenoidectomy also can be performed using laryngofissure or endoscopic laser excision. Subglottic ste nosis is the 3rd most common congenital anomaly. Anterior or multiple crico id splitting with cartilage graft interpositioning is usually performed. Th e success rates for these procedures has been shown to be approximately 90% . (Am J Otolaryngol 2000;21:22-30. Copyright (C) 2000 by W.B. Saunders Comp any).