Successful plication operation of arytenoid mucosa in 2 patients with laryngomalacia

Abstract

Laser cauterization of flaccid arytenoid mucosa is reported to be an effective surgical method for treating arytenoid type laryngomalacia. However, postoperative complications such as supraglottic strictures due to adhesions in the arytenoid region, as well as granulations have been reported. We describe 2 patients with acquired arytenoid type laryngomalacia, in whom cauterization of flaccid arytenoid mucosa and plication of both sides of the cauterized areas were performed. Preventative treatment was also provided to reduce the risk of granulations and adhesions in the arytenoid region. The first case involved a 2-year, 9-month-old girl who was originally healthy but had anoxic encephalopathy due to status epilepticus. She began receiving nasogastric intubation for nutritional support. Inspiratory stridor was observed 2 months after onset, and she was diagnosed as having arytenoid type laryngomalacia. A significant decrease of SpO2 was not observed, but due to the child’s severely labored breathing and the family’s wishes, a surgical treatment plan was chosen. The second case involved a 1-year, 3-month-old boy later diagnosed as having Joubert syndrome. When the child was hospitalized to undergo polydactyly surgery, inspiratory stridor and decreased peripheral oxygen saturation (SpO2) were observed, and he was diagnosed as having arytenoid type laryngomalacia. As his condition required oxygenation, a surgical treatment plan was deemed the best course of action. In both cases, the children’s respiratory conditions improved postoperatively. No relapses were observed. These cases indicate that modification of plication operations is effective in preventing the granulations that result in relapse, particularly in patients in whom nasogastric intubation will likely continue.