Epiglottopexy for Severe Laryngomalacia with Epiglottic Prolapse

Contributors: Deepak Mehta (Children’s Hospital of Pittsburgh of UPMC)

Laryngomalacia is the most common cause of stridor in newborn infants. The majority of cases resolve spontaneously. Common surgical therapy consists of division of the aryepiglottic folds combined with trimming of the arytenoid mucosa and/or cuneiform cartilages. Less frequently, epiglottopexy is required. Initially, flexible laryngoscopy illustrated prolapse of the epiglottis into the laryngeal lumen causing severe obstruction. Microlaryngoscopy, bronchoscopy, and supraglottoplasty (division of the aryepiglottic folds only) were performed, however improvement did not occur due to persistent epiglottic prolapse. Transoral epiglottopexy was performed. A Lindholm laryngoscope was used for exposure. A needle point cautery was used to remove the mucosa of the lingual surface of the epiglottis and the base of tongue. Alternatively, a carbon dioxide laser could used. 5-0 polydioxanone suture on a P-2 needle was to suspend the epiglottis to the base of tongue using 3 sutures. Photographs of the suspension conclude the procedure.

DOI: http://dx.doi.org/10.17797/locmhv8x9q