condition on which a child born-with and associated with other congenital abnormality of the larynx.

1. LARYNGOMALACIA
PRESENTOR:-MSHANGA MJEMMAS,RESIDENT.
SUPERVISOR:-DR: DESDERIUS CHUSSI,Mmed ENT.
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2. CONTENTS:-
 DEFINITION.
 EPIDEMIOLOGY.
 RISK FACTOR AND ETIOLOGY.
 TYPES AND GRADING.
 CLINICAL PRESENTATIONS.
 MANAGEMENTS.
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3. DEFINITIONS:
 Anomaly of a newborn characterized by flaccid laryngeal tissue and
inward collapse of the supraglotic structure leading into upper airway
obstruction.
 Is the most common cause of congenital stridor and most common
congenital lesion of the larynx.
 It is characterized by partial or complete collapse of arytenoids,
epiglottis and aryepiglottic folds structures on inspiration.
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4. Continue:
 White population are more affected.
 Predominance of male 58%-76% cases.
 some areas report no significant differences between male and female.
 At age of 4-6 weeks, but inspiratory flow rates may not be high enough to
generate the sounds. Symptoms may seen at 6-8 months of life.
 Mortality is rarely unless in severe cases and may be associated with
GERD.
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5. ETIOLOGY
1. Cartilage immaturation: Both arytenoids and epiglottis are involved,
elongated epiglottis may fold to itself, while the arytenoid may enlarge
and become floppy which may prolapse over the larynx during
inspiration.
2. Anatomical abnormality: Shortening of the aryepiglottic and anterior
collapse of cuneiform and corniculate cartilage.
3. Neuromuscular immaturity: development of neuromuscular hypotonic,
altered of laryngeal tone and sensorimotor integrative functions.
4. Inflammatory causes: recurrent reflux induce supraglotic edema and
secondary LM.
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6. TYPES OF L.M (structural appearance)
 Type 1: inward collapse of aryepiglottic folds.
 Type 2: long tubular epiglottis infolding on its self(omega shape)
 Type 3: anterior and medial collapse of corniculate and cuneiform
cartilage.
 Type 4: posterior displacement of epiglottis against posterior
pharyngeal wall or inferior collapse towards vocal folds.
 Type 5: short aryepiglottic folds.
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8. Types of Laryngomalacia.(onset)
1 -Infantile Laryngomalacia:
 Symptoms occur early in life.
 Improve by the age of 2 years
2 -Late onset Laryngomalacia:
 Children > 2 years.
 Present during feeding, exercise or sleep.
 Presented by snoring or OSA.
3 -State Dependent Laryngomalacia:
 Older age group / Adults.
 Occurs only during sleep.
 Diagnosed by sleep endoscopy.
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9. DEGREE OF LARYNGOMALACIA:
 MILD LARYNGOMALACIA.
 Noise breathing or inspiratory stridor.
 No significant airway obstructions or feeding difficulties.
 Usually outgrow the stridor by 12-18months of age.
 MODERATE LARYNGOMALACIA.
 Inspiratory stridor.
 Feeding difficulties without “poor weight gain”
 Choking food.
 On/off gastroesophageal reflux.
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10. Continue:-
 SEVERE LARYNGOMALACIA.
 Feeding difficulties with “poor weight gain”
 Significant cyanosis.
 Life threatening apnea.
 Severe airway symptoms enough to cause multiple emergency visits.
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11. Clinical presentations:
 Stridor: low pitched inspiratory sound more marked on supine
position, feeding, crying.
 Feeding symptoms: choking, coughing, prolonged feeding, dysphagia,
weight loss.
 Apnea
 Pulling in neck and chest with each breath.
 Cyanosis.
 Aspirations.
 Gastro esophageal reflux.
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12. Diagnosis:
 History and physical examinations.
 Investigations follows:
i. Flexible fibreoptic laryngoscopy.
ii. Micro laryngoscopy and bronchoscopy.
iii. Chest x ray r/o aspirations.
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13. Treatments:
 Observations:
- condition tends to disappear at the age of 2years.
 Medical management:
- feeding modalities and acid reflux suppression.
 Surgical management:
- supraglottoplasty, epiglottopexy, tracheostomy.
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14. Surgical indication:
 Hypoxia.
 Recurrent cyanosis.
 Co pulmonale.
 Stridor with significant retractions.
 Failure to thrive.
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15. References:
 Scott-Brown’s Otorhinolaryngology Head and Neck Surgery
VOLUME 2
 Internet sources.
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