Layngomalacia

LARYNGOMALACIA
  • It is the most common congenital abnormality of the larynx. 
  • Laryngomalacia is the most frequent cause of stridor or noisy breathing in newborn/infants/young children.
  • It occurs as a result of a floppy portion of the larynx (in supraglottic larynx) that has not yet developed the strength to provide rigid support to the airway.
  • During inspiration negative pressure is created through larynx, which results in a collapse of these structures into the airway and a narrower breathing passage.
  • Partial obstruction is the source of the noise with breathing (stridor), and sometimes cyanosis.
  • The hallmark sign includes intermittent stridor mostly in inspiration. It is usually more prominent when the infant is lying on his/her back (supine position, crying, feeding, excited or has a cold.
  • This is usually first noticed in the first few weeks of life.
  • Stridor reduces when the child is in prone position and is quiet.
  • It may worsen over the first few months and become louder. This is because as the baby grows, inspiratory force is greater, which causes greater collapse of the laryngeal structures into the airway. This is usually worst at 3-6 months and then gradually improves as the rigidity of the cartilage improves.
  • Most children are symptom free by 1 to 2 years.
  • Sometimes, cyanosis may occur.
  • Direct laryngoscopy shows :-
  • Omega shaped epiglottis, i.e. elongated and curled on itself.
  • Floopy, tall, foreshortened and thin aryepiglottic folds.
  • Prominent arytenoids.
  • In most patients laryngomalacia is a self-limiting condition.
  • Treatment of laryngomalacia is wait and watch and reassurance to the parents and early antibiotic therapy for upper respiratory tract infections.
  • Tracheostomy is required only in severe respiratory obstruction.
  • Surgical intervention (supraglottoplasty i.e. reduction of redundant laryngeal mucosa) is indicated for 10% of patients. Main indica­tions for surgery are:
  1. Severe stridor
  2. Apnea
  3. Failure to thrive
  4. Pulmonary hypertension
  5. Cor pulmonale
Exam Question
  • Omega shaped epiglottis is seen in Laryngomalacia.
  • Most likely cause in a 3 month old child presenting with intermittent stridor is Laryngomalacia.
  • Most common cause of stridor shortly after birth is Laryngomalacia.
  • Laryngomalacia is the commonest cause of stridor in a newborn who is born at term, infants and young children.
  • Treatment of choice in a newborn presented with stridor due to laryngomalacia is only observation.No active treatment.
  • Reassuarance of the patient is the treatment of choice in Laryngomalacia.
  • Most likely cause for a 2-month old infant having inspiratory stridor since the first month of life, otherwise well, Physical examination shows moderate inspiratory stridor and retractions which are worse when the infant is supine or agitated and better when he is prone and quiet is Laryngomalacia.
  • Most common congenital anomaly of larynx is Laryngomalacia.
  • Inspiratory Stridor is seen in Laryngomalacia.
  • Surgical management is not the preferred initial treatment in Laryngomalacia.
  • Laryngomalacia is self-limiting by 2-3 years of age.
  • Most common neonatal respiratory lesion is Laryngomalacia.
  • Laryngomalacia is first noticed in the first few weeks of life by inspiratory stridor
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