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We present transoral endoscopic supraglottoplasty in a 6-month-old infant with Grade 3 laryngomalacia, recurrent aspiration pneumonia, and failure to thrive. Following exposure with a Macintosh laryngoscope, the endolarynx was visualized and all three anatomical abnormalities were addressed. The midline glossoepiglottic ligament was vaporized to induce fibrosis and anteriorize the epiglottis, avoiding the need for epiglottopexy. The superior epiglottic surface was freshened just medial to its lateral edges to promote fibrosis and restore its normal petiole configuration. The aryepiglottic folds were divided in midline with cold-steel scissors to the level of the false vocal folds, and laser ablation was used to remove redundant mucosa overlying the arytenoid cartilages.
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