Endoscopic division of the ary-epiglottic folds in severe laryngomalacia

Objective: Laryngomalacia is the commonest cause of congenital strider. The underlying anatomical abnormality associated with this condition is a prol apse of the supraglottic tissues into the laryngeal inlet during inspiratio n, and may involve the epiglottis, ary-epiglottic folds and the corniculate mounds of the arytenoids. However, it has been noted that the most consist ent structural abnormality seen in these cases is the shortening of the ary -epiglottic folds and marked side to side curling of the epiglottis. We des cribe the follow-up and outcome of 33 cases treated by the simple division of the ary-epiglottic folds. Method: All case notes were reviewed with resp ect to indications of operation, age of operation, endoscopic findings, ope rative technique, complications and follow-up until resolution of symptoms. Results: Surgical outcomes could only be ascertained in only 32 patients. Twenty-two cases (68.7%) showed complete resolution of strider and associat ed complications of laryngomalacia. In the remaining ten cases who could be followed up (31.2%;,), seven patients (21.8%) showed partial resolution wi th no further surgery required, two patients (6.2%) required additional exc ision of redundant mucosa as second procedure, one patient (3%) with associ ated cleft lip/palate and tracheomalacia had to undergo a tracheostomy. The re was improvement in feeding after surgery in all the 12 patients (100%) w ho had had pre-operative feeding difficulties. All the four patients with c yanosis pre-operatively were cured, but one of the two patients with apnoei c episodes pre-operatively continued to have apnoeic spells despite resolut ion of their laryngomalacia. Conclusion: Simple endoscopic excision of the ary-epiglottic folds is a quick, reliable, highly effective procedure with very few complications. We recommend its use as the first line option ill t he management of severe laryngomalacia, with more extensive methods reserve d for the very occasional case of primary failure. (C) 2001 Elsevier Scienc e Ireland Ltd. All rights reserved.