4. LARYNGOMALACIA MALACIA= SOFTENING (GREEK) JACKSON IN 1942 MOST COMMON CAUSE OF CONGENITAL STRIDOR. FEATURES: 1. SOFT FLABBY LARYNGEAL TISSUES 2. THIN LARYNGEAL CARTILAGES 3. LOOSE, REDUNDANT MUCOSA OF LARYNX
5. C/F: M:F= 1:1, CRY IS NORMAL INSPIRATORY STRIDOR: HIGH PITCH, “FLUTTERING” , WITHIN FEW DAYS OF BIRTH , OR URTI INCREASES TILL FIRST YEAR STARTS RESOLVING. SUPINE POSITION, SUCKLING, CRYING WORSENS STRIDOR IMPROVES IN PRONE POSITION
6. DIAGNOSIS: HISTORY VIDEOLARYNGOSCOPY/FLEXIBLE NASO LARYNGOSCOPY: 1. OMEGA SHAPED EPIGLOTTIS 2. SHORT AE FOLD, PROLAPSES INWARDS 3. PROMINENT ARYTENOIDS, LOOSE MUCOSA, MOVE INWARDS 4. DIFFICULT TO SEE VOCAL CORDS
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9. TREATMENT: 1. 90% CASES RESOLVE BY 2 YEARS 2. TREAT URTI EFFECTIVELY SEVERE RESPIRATORY DISTRESS, FEEDING DIFFICULTY( HIGH INTRA THORACIC NEGATIVE PRESSURE GERD ) WITH FAILURE TO THRIVE ACTIVE INTERVENTION
11. CONSERVATIVE MANAGEMENT ENDOSCOPIC ARY- EPIGLOTTOPLASTY ( SUPRAGLOTTOPLASTY) CO2 / COLD KNIFE AE FOLD RELEASED FROM EPIGLOTTIS & REDUNDANT MUCOSA OF ARYTENOID EXCISED IF NEEDED ALONG WITH CUNEIFORM CARTILAGES
12. LARYNGOCELE AIR-FILLED DILATATION OF SACCULUS ETIOLOGY: 1. CONGENITALLY LARGE SACCULE 2. INCREASED INTRA LARYNGEAL PRESSURE GAS BLOWERS, SAXOPHONE PLAYERS, COUGHING etc
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14. TYPES: Internal- within the larynx External- Projects through the thyro-hyoid membrane and presents as swelling in the lateral neck Combined
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16. CLINICAL FEATURES Asymptomatic Hoarseness RESPIRATORY DISTRESS INCREASES ON CRYING OR STRAINING Neck: Cystic, painless swelling, reducible, increases on valsalva ILS: Smooth bulge on the ventricular band, may obscure the vocal cords
17. BRYCE’S SIGN: GIRGLING & HISSING SOUND IN THROAT WHEN EXTERNAL MASS IS COMPRESSED IF SAC OPENING IS OBSTRUCTED MUCOCELE ( SACCULAR CYST )
18. MANAGEMENT SOFT TISSUE XRAY NECK/ CT SCAN DURING VALSALVA DIRECT LARYNGOSCOPY TO RULE OUT UNDERLYING MALIGNANCY TREATMENT: MLS & MARSUPIALIZATION OF SAC (VENTRICULAR BAND & LARYNGOCELE IS CUT & MARGINS EVERTED) EXTERNAL (TRANSCERVICAL) EXCISION (EITHER CUT THE NECK OF SAC & SUTURE OR LARYNGOFISSURE & SAC EXCISION)
19. LARYNGEAL WEB FAILURE OF COMPLETE CANALIZATION OF LARYNX DURING 5TH WEEK OF IU LIFE MOST COMMON IS GLOTTIC WEB(75%), LESS COMMON ARE SUPRA & SUB GLOTTIC MOSTLY ANTERIOR GLOTTIC WEBS POSTERIOR INTERARYTENOID WEBS MAY BE ASSOCIATED WITH CRICOARYTENOID JOINT FIXATION
20. C/F: WEAK CRY AT BIRTH RECURRENT CROUP INSPIRATORY OR BIPHASIC STRIDOR DIAGNOSIS: VIDEODIRECT ENDOSCOPY/ FLEXIBLE NASOLARYNGOSCOPY
26. PREFERABLY KEEL INSERTED AT AGE OF 3 YRS & ABOVE TEMPORARY TRACHEOSTOMY WHEN KEEL IN-SITU ( 2- 5 WEEKS) INSERTED ENDOSCOPICALLY WITH COMBINEDLARYNGOFISSURE APPROACH VERY SEVERE WEB INVOLVING SUBGLOTTIS EMERGENCY TRACHEOSTOMY AT 2 yrsLTR ( Laryngo tracheal reconstruction) WITH ANTERIOR CARTILAGE GRAFTING
