Laryngomalacia Flashcards
Define laryngomalacia
Most common congenital anomaly of the larynx - inward movement of suprglottic structures during inspiration = partial airway obstruction.
What is the relevant epidemiology of laryngomalacia?
Most commonly in infants, mainfests within first two weeks of life, tends to self resolve by 18 to 24 months as laryngeal cartilage matures.
What is the most common cause of stridor in neonates?
Laryngomalacia
What are the risk factors for laryngomalacia?
Males “2:1
Premature birth - immature neuromuscular control and cartilaginous support
Firstborn - maternal or environmental factors
What are some underlying causes of laryngomalacia?
NM immaturity - low tone or coordination or arytenoid muscles (prem or CP)
GERD - exacerbate collapse by causing inflammation and oedema, or GERD may be consequence of
Anatomy - congential shortening or malpositioning of the aryepiglottic folds
What is the relevant pathophysiology of laryngomalacia?
Immature and flopy arytenoid cartilages and surrounding tissues = structural weakness
Shortening of aryepiglottic folds = inward buckling of structures
Poor neuromuscular control
May also show GERD
During increase negative pressure of the airwats during inspiration, laryngeal tissue collapses inwards, causing an obstruction
What are the three different classifications of laryngomalacia?
Classified by anatomy of collapse
Type 1 = curling type = mucosa overlying arytenoids 75%
Type 2 = prolapsing - mucosa overlying cuneiform and corniculate = 15%
Type 3 - posterior displacement - 10% - malpositioning of epiglottis and folds - typically more severe
What are the clinical features of laryngomalacia?
Inspiratory stridor - high pitched and crowing. Usually intermittent, most common in supine position, agitated or feeding
Increase in severity for first 8 months, then resolve by 18-24months.
Resp distress, failure to thrive and cyanosis are rare.
What investigations should be done for laryngomalacia?
Oxygen saturations should be monitored and blood gas taken if desaturation.
laryngoscopy and bronchoscopy is severe features or diagnostic difficulty.
What is the typical management of laryngomalacia?
99% spontaneous resolved between 18-24months
Symptomatic relief - hyperextending the neck
Surgical - if severe - tracheostomy, laryngoplasty, excision of mucosa etc
What are some complications of laryngomalacia?
Failure to thrive - inc breathing and feeding difficulties - growth retardation
Resp distress - apnoea etc
GERD
Sleep apnoea
Pneumonia - aspiration or LRTI
Pulmonary HTN - due to chronic hypoxemia.
