Laryngomalacia is the most common laryngeal anomaly affecting newborns. Patient’s with severe disease should be considered for supraglottoplasty. It classically presents in a newborn with high-pitched inspiratory stridor that worsens with exertion, supine-positioning, and feeding. It is characterized by anatomic and physiologic abnormalities including shortened aryepiglottic (AE) folds, small, tightly curled epiglottis, redundant soft tissue overlying the cuneiform or accessory cartilages and reduced laryngeal tone. Any combination of these may present with laryngomalacia. Most cases are mild and resolve with observation or medical therapy.
Steps:
1. Laser precautions are taken to protect patient and personnel.
2. Spontaneous ventilation
3. Suspension laryngoscopy is performed with adequate visualization of the larynx.
4. The operating telescope or microscope is used for visualization. The CO2 laser is tested.
5. First, division of the AE folds is performed.
6. Next, redundant mucosa and tissue overlying the accessory cartilages is ablated.