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Hong Kong 2008
Hong Kong 2008
Collapse of the (supraglottic) larynx
Inspiratory because of Bernoulli effect
Hong Kong 2008
- ve- ve
- veExtra-thoracic
Intra-thoracic
Hong Kong 2008
Not usually present at birth (first week)
with feeding and crying
musical quality
cry normal
(cyanotic episodes unusual)
growth/weight
Hong Kong 2008
Inspiratory stridor with crying
Recession
Check for cutaneous haemangiomata
Hong Kong 2008
Aims to confirm diagnosis of laryngomalacia
to exclude co-existant airway pathology
Options
Fibre-optic in office – screening for all
MLB under GA for full assessment
Hong Kong 2008
Intubation history
Traumatic birth
Stridor from day 1
Cyanotic episodes
Failure to thrive
Biphasic stridor
Severe recession
Other congenital abnormalities
Abnormal neurology
Hong Kong 2008
Hong Kong 2008
Hong Kong 2008
Posterior - common
Combined – less common
Anterior - rare
Severe combined laryngomalacia
Hong Kong 2008
Conservative For majority
Surgical
Severe airway obstruction
(would otherwise need tracheostomy)
Failure to thrive
Which procedure? determined by site and severity
? Antibiotics/steroids/antireflux
Hong Kong 2008
Feeding difficulties
- primary or secondary to laryngomalacia?
Floppy baby
Syndromic child
Hong Kong 2008
Mucosal excision
Tailored to suit
Hong Kong 2008
Sheffield snip
Hong Kong 2008
Laser
Slow to feed
Hong Kong 2008
Mild
very common
self limiting
observe ? Scope
Significant
trim excess mucosa
(avoid if syndromic, floppy or concerns that
feeding may worsen)
Hong Kong 2008
Disease profile Definition Classification Prognosis Associations
Diagnosis
Treatment
Hong Kong 2008
Abnormal collapse of the trachea
Expiratory because of increased intra-thorasic pressure
Hong Kong 2008
+ ve+ ve+ ve
Extra-thoracic
Intra-thoracic
+ ve
+ ve+ ve
Hong Kong 2008
Cartilage to muscle Ratio should be 2:1
Hong Kong 2008
Compression
Vascular
Mediastinal Mass
Long term ventilation
Hong Kong 2008
Hong Kong 2008
Hong Kong 2008
May initially deteriorate over first 6 months then usually improves by 18 months as cartilage strengthens
Can be severe
(if combined with bronchomalacia can be fatal due to inability to ventilate/empty chest)
Hong Kong 2008
Larsen’s Syndrome
hypermobile joints
cartilage
Tracheo-oesophageal fistula
Cardiac lesions
Hong Kong 2008
Cyanotic episodes
Tracheomalacia, TOF, cardiac
Cough
Tracheomalacia,TOF
Aspiration
TOF, VCP, Cleft
Hong Kong 2008
Timing of stridor (inspy/expy)
? prolonged expiratory phase
Hong Kong 2008
Hong Kong 2008
MLB
Avoid physical or airway splinting
(underdiagnosis)
Coughing (overdiagnosis)
Bronchography
CT/MRI (2D or 3D)
Echocardiogram
Hong Kong 2008
Long tracheostomy tube
CPAP
Hong Kong 2008
Aortopexy ? thorascopic
Bronchopexy
Stents
Hong Kong 2008
Mild -
common, self limiting
? Relationship to breath-holding attacks
Severe
tracheostomy
aortopexy/stent
can be a real challenge or even fatal
Hong Kong 2008
