Surgical management of severe laryngomalacia.

Infants and children with laryngomalacia exhibit varying degrees of upper airway obstruction and dysphagia. Although the disorder is usually self-limited, the potential exists for symptoms so severe that operative intervention cannot be avoided. Relief of progressive airway compromise traditionally has involved bypassing the obstruction with tracheotomy. Recently, endoscopic surgical management of the most severe cases has been reexamined by the authors and others. Thirteen infants and children underwent supraglottoplasty (also referred to as epiglottoplasty or partial arytenoidectomy) for severe, complicated laryngomalacia. Endoscopic laser removal of flaccid supraglottic tissue resulted in improvement of the airway in all patients. In most patients, associated symptoms improved or completely resolved. Supraglottoplasty is an effective alternative to tracheotomy in carefully selected patients with severe laryngomalacia.