Transoral treatment for severe laryngomalacia. Review and presentation of a modified operative technique.

Laryngomalacia is the most common cause of strider in children. So far vari ous authors have described surgical techniques in a sense of a supraglottop lasty or an epiglottoplasty to handle the severe form of this disease. We p resent a modified technique of the so called epiglottopexy. Methods: Under the different types of laryngomalacia this study focusses on the treatment of three patients (5 to 10 months) with a posterior displacement of the epi glottis during inspiration. The first step of our technique was to denude a small portion of the base of the tongue from mucosa. A corresponding lesio n was created on the lingual surface of the epiglottis. The vaporisation of the mucosa was performed with the CO2 laser at a power setting of 1 Watt a nd a 0.25 mm spot size. The epiglottis was then fixed transorally to the ba se of the tongue with 2 single stitch sutures and 1 inverse matress suture, using a resorbable material. Results: No intra- or postoperative complicat ions were observed. All three patients demonstrated a significant airway im provement without strider. Conclusion: The presented technique of transoral laser surgical epiglottopexy seems to be a method suitable for the treatme nt of laryngomalacia caused by posterior displacement of the epiglottis.