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Congenital Laryngomalacia


Presentation

  • Abstract There is at present, very little information on congenital laryngomalacia in the anaesthetic literature.[ncbi.nlm.nih.gov]
  • We present a unique case all three entities. The diagnosis was confirmed on direct laryngoscopy and the cleft successfully repaired endoscopically.[ukm.pure.elsevier.com]
  • […] if the condition was present at the time of inpatient admission.[icd.codes]
  • Canadian Journal of Anesthesia/Journal canadien d'anesthésie, Apr 1994 There is at present, very little information on congenital laryngomalacia in the anaesthetic literature.[paperity.org]
  • Clinical Findings Patients with LM present with inspiratory stridor. Stridor is seldom present at birth but usually starts within the first few days to weeks of life.[radiologykey.com]
Feeding Difficulties
  • This severe form presents as persistent sternal recession, feeding difficulties, and failure to thrive, progressing to apnoeic attacks, cor pulmonale and eventually death.[ncbi.nlm.nih.gov]
  • difficulties, swallowing dysfunction, failure to thrive, and respiratory distress.[orpha.net]
  • There is no significant airway obstruction, no feeding difficulties, or other symptoms associated with laryngomalacia. The noisy breathing is annoying to caregivers, but does not cause other health care problems.[childrenshospital.vanderbilt.org]
Hyperthermia
  • Other than triggering malignant hyperthermia in susceptible patients, succinylcholine-induced fasciculations can cause fractures and neck hyperextension leading to atlanto-occipital dislocations. It was therefore avoided in our case.[ijaweb.org]
Inguinal Hernia
  • Diagnosis of a right-sided obstructed, irreducible indirect inguinal hernia was made. The paediatric surgeons reduced the hernia and a semi-elective herniotomy was planned.[ijaweb.org]
Inspiratory Stridor
  • Prolapse of supraglottic tissues produces a variable amount of airway obstruction and inspiratory stridor. A majority of infants have mild disease and are managed expectantly.[scholars.northwestern.edu]
  • However when present, it accounts for severe inspiratory stridor, causing airway compromise, and sometimes even death. Laryngomalacia is the commonest congenital anomaly of the larynx, which is present after birth giving rise to inspiratory stridor.[laryngologyandvoice.org]
  • The patient was a known case of congenital laryngomalacia with inspiratory stridor which decreases on being prone. On examination, bilateral crepitations were present in both the lung fields with mild inspiratory stridor and heart rate of 126/min.[saudija.org]
  • Clinical Findings Patients with LM present with inspiratory stridor. Stridor is seldom present at birth but usually starts within the first few days to weeks of life.[radiologykey.com]
  • Homepage Rare diseases Search Search for a rare disease Congenital laryngomalacia Disease definition A rare larynx anomaly characterized by an inward collapse of supraglottic airway during inspiration, which manifests with an inspiratory stridor and might[orpha.net]
Tracheal Tug
  • Referral to a specialist such as the Children’s ENT and Facial Plastic Clinic is appropriate if one or more of the following criteria are met in addition to noisy breathing/stridor: Respiratory distress- tachypnea, retractions, tracheal tugging, apnea[childrensmn.org]
Choking
  • Other symptoms may include: difficulty feeding poor weight gain choking while feeding apnea (pauses in breathing) pulling in neck and chest with each breath cyanosis (blue spells) gastroesophageal reflux (spitting, vomiting and regurgitation) Inhalation[childrenshospital.org]
  • Click here to view Case 2 A 2-month-old infant was referred from PICU with history of inspiratory stridor, choking sensation and difficulty in feeding since 10 days.[laryngologyandvoice.org]
  • Become less noisy when the baby is lying on his or her belly Get worse if your baby has an upper respiratory infection, like a cough or cold Other symptoms of more severe congenital laryngeal stridor can include: Difficulty feeding Poor weight gain Choking[cooperhealth.org]
  • Other symptoms that can be associated with laryngomalacia include: Feeding difficulties Poor weight gain (failure to thrive) Regurgitation of food (vomiting or spitting up) Choking on food Gastroesophageal reflux (spitting up acid from the stomach) Chest[childrenshospital.vanderbilt.org]
Acute Abdomen
  • Here, we share our experience of anaesthesia management of an infant with congenital laryngomalacia and recently diagnosed osteogenesis imperfecta type 1 who had presented to us with an acute abdomen for a semi-emergency herniotomy.[ijaweb.org]
Constipation
  • A 6-month-old male infant, 3.5 kg in weight, presented with the history of refusal to feed, tender abdomen, swelling in the right groin and constipation since 3 days.[ijaweb.org]
Neonatal Jaundice
  • The infant was kept in the intensive care unit (ICU) for 3 days post-delivery for breathing difficulties and neonatal jaundice. Anaesthesia pre-evaluation revealed microretrognathia [Figure 1].[ijaweb.org]
Jaundice
  • The infant was kept in the intensive care unit (ICU) for 3 days post-delivery for breathing difficulties and neonatal jaundice. Anaesthesia pre-evaluation revealed microretrognathia [Figure 1].[ijaweb.org]
Blue Sclera
  • Subsequent paediatric, orthopaedic and ophthalmologic evaluations revealed blue sclera, spontaneous rib fractures, failure to thrive and multiple hernias (umbilical and right inguinal) because of the lax abdominal wall.[ijaweb.org]
Fracture
  • Facial anomalies associated with osteogenesis imperfecta like retrognathia, combined with a large head, short neck and propensity to mandibular fractures make mask ventilation difficult.[ijaweb.org]
Petechiae
  • […] and fractures occurring intraoperatively may go unnoticed. [7] Patients of osteogenesis imperfecta have a tendency for bleeds in spite of having a normal coagulation profile and bleeding time. [8] Coagulopathy with a sudden development of widespread petechiae[ijaweb.org]
Short Neck
  • Facial anomalies associated with osteogenesis imperfecta like retrognathia, combined with a large head, short neck and propensity to mandibular fractures make mask ventilation difficult.[ijaweb.org]

Workup

  • The findings underline the heterogeneity of childhood respiratory disease and the importance of considering early life factors when performing diagnostic workup.[adc.bmj.com]
  • If the baby has normal cry, normal weight gain, normal development, and purely inspiratory noise that developed within the first 2 months of life, then no further workup may be necessary.[emedicine.medscape.com]

Treatment

  • Finally circulatory collapse may occur or may die of asphyxia or cardiac failure. 100 Treatment Ⅰ :etiological treatment, antibiotics and corticosteroid. 101 Treatment Ⅱ :etiological treatment. in case of tumors of the larynx, trauma, bilateral vocal[slideplayer.com]
  • Supraglottoplasty is the mainstay of surgical treatment; tracheostomy is rarely needed.[scholars.northwestern.edu]
  • Its diagnosis and a résumé of the various treatment strategies, will be presented. The anaesthetic management is controversial as is the surgical technology.[ncbi.nlm.nih.gov]
  • Our team provides the most advanced testing and surgical treatments available for this condition.[childrenshospital.org]
  • Some babies, however, develop severe breathing problems that need treatment.[cooperhealth.org]

Prognosis

  • Aim: The aim of this study was to assess clinical presentation, management and prognosis of infants and children suffering from laryngomalacia presented to our department in the period of 5 years.[nature.com]
  • Treatment and prognosis Treatment is largely supportive since most children show spontaneous resolution after 12-24 months. When associated gastro-esophageal reflux disease is present, that should be treated.[radiopaedia.org]
  • Conclusion: In most children, the prognosis is favorable, as airway obstruction is not severe, and the symptoms improve in patients younger than 2 years.[thieme-connect.com]
  • Prognosis [ edit ] Laryngomalacia becomes symptomatic after the first few months of life (2–3 months), and the stridor may get louder over the first year, as the child moves air more vigorously.[en.wikipedia.org]

Etiology

  • The goal of this study was to elucidate the etiology of decreased laryngeal tone through evaluating the sensorimotor integrative function of the larynx.[ncbi.nlm.nih.gov]
  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Congenital laryngeal stridor (laryngomalacia): Etiologic factors and associated disorders. Ann Otol Rhinol Laryngol 1984 ;93: 430 – 7. Google Scholar SAGE Journals ISI 5. Sutherland, GA, Lack, HL. Congenital laryngeal obstruction.[journals.sagepub.com]
  • Chronic pediatric stridor: etiology and outcome. Laryngoscope. 1990;100:277–80. PubMed Google Scholar 9. Zoulmalan R, Maddalozzo J, Holinger LD. Etiology of stridor in infants. Ann Otol Rhinol Laryngol. 2007;116(5):329–34.[link.springer.com]

Epidemiology

  • Epidemiology Laryngomalacia (LM) is the most common congenital laryngeal abnormality and accounts for 60% of laryngeal problems in the newborn. It is the most common cause of stridor in infants.[radiologykey.com]
  • Epidemiology [ edit ] Although this is a congenital lesion, airway sounds typically begin at age 4–6 weeks. Until that age, inspiratory flow rates may not be high enough to generate the sounds.[en.wikipedia.org]
  • […] neuromuscular control of the supportive cartilaginous structures of the airway Supraglottic edema due to laryngeal inflammation Most cases of laryngomalacia resolve by 18-24 months, however, 10% will present with severe features requiring surgical intervention Epidemiology[medicine.uiowa.edu]
  • Epidemiology • commonest cause ( 65%) of stridor in infants – (17% have another intercurrent airway lesion) • may occur in older children & adults • more common in male and term baby • Association with other syndromes and neurologically-impaired (e.g.[slideshare.net]
  • Cidofovir, a new antiviral agent approved for ocular cytomegalovirus infections, has shown promise as a local injection in adjuvant therapy. ⑷ Autogenous vaccine. 69 70 Carcinoma of the larynx Dong pin 71 Epidemiology Accounts for 1% of all new cancers[slideplayer.com]
Sex distribution
Age distribution

Pathophysiology

  • The developmental and functional anatomy of the larynx will be included, with a discussion of the pathophysiology and history of the disorder. Its diagnosis and a résumé of the various treatment strategies, will be presented.[ncbi.nlm.nih.gov]
  • Pathophysiology and diagnostic approach to laryngomalacia in infants. Eur Ann Otorhinolaryngol Head Neck Dis. 2012;129:257–63. CrossRef PubMed Google Scholar 11. Giannoni C, Sulek M, Friedman EM, Duncan III NO.[link.springer.com]
  • Tracheomalacia Pathophysiology – expiratory collapse of the intrathoracic airway, due to defective cartilaginous support.[pedclerk.bsd.uchicago.edu]

Prevention

  • Extubation should incorporate an effective comprehensive plan to prevent cannot intubate and cannot ventilate situation.[saudija.org]
  • Premedication of patients with laryngomalacia is essential to prevent vagal responses and as an antisialogogue, sedation is to be used judiciously.[ijaweb.org]
  • What they found adds to... [ Read Full Story ] May 10, 2019 If your provider is ordering nebulizers and the drugs used in them for their patients here are things in the documentation that will help prevent a resubmission to Medicare and ease medical coding[coder.aapc.com]
  • Centers for Disease Control and Prevention Intersex (Medical Encyclopedia) [ Read More ] Throat Disorders Also called: Pharyngeal disorders Your throat is a tube that carries food to your esophagus and air to your windpipe and larynx.[icdlist.com]
  • Use of CO 2 laser is justified as it facilitates removal of the cyst, prevents edema, and recurrence.[laryngologyandvoice.org]

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