喉頭軟化症 (喉頭軟弱症，laryngomalacia) は乳児期の吸気性喘鳴の原因として最も多い疾患であり，5～10％の重症例が外科治療を必要とする。Olneyの分類では，type 1披裂部の余剰粘膜が吸気時に吸い込まれる，type 2披裂喉頭蓋ヒダが短い，type 3喉頭蓋が吸気時に倒れこむように吸い込まれる，の3つに分類され，複数のタイプが重複することもある。喉頭顕微鏡下手術はtype 1に対しては披裂部余剰粘膜の切除，type 2に対しては披裂喉頭蓋ヒダ短縮部の切離，type 3に対しては喉頭蓋の舌根部への吊り上げ縫合を行い，重複例にはそれぞれの手術を組み合わせて行う。本稿では喉頭軟化症の病態と診断，当院での重症例に対する喉頭顕微鏡下手術の経験を中心に治療について考察する。

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Laryngomalacia is one of the most common forms of laryngeal stenosis in newborns and infants. We reported two cases of laryngomalacia that were treated with surgical intervention for intractable dyspnea and dysphagia. A 4-year-old girl with complication due to cerebral palsy presented with progressive inspiratory stridor and saliva aspiration. Combined type laryngomalacia was diagnosed and she underwent a tracheotomy. A 2-year-old boy suffered from brain injury incurred from domestic violence at 4-months of age. He presented with inspiratory dyspnea followed by repeated aspiration bronchitis. Endoscopic examination revealed strongly flaccid arytenoid mucosa. The mucosal lesion was resected with a CO₂ laser. A retrospective review of the charts of 13 cases of laryngomalacia in our hospital revealed that 9 cases (69%) were arytenoid type and 3 (23%) were combined type. Ten cases (77%) were complicated with central nervous system (CNS) disorders such as cerebral palsy. Besides dyspnea, swallowing disturbance was a major symptom in the cases. Generally symptoms will decrease with a physical growth; however, those cases with CNS disorders, gastroesophageal reflux, or additional laryngeal anomalies tended to have persistent symptoms. In such cases, surgical intervention might be indicated.

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Laryngeal cleft（LC）is rare congenital abnormal malformation. It is considered to be developmental anomalies due to failure of the fusion of the tracheoesophageal septum from fourth to eight embryonic weeks. LC have a number of airway symptom including aspiration and recurrent pneumonia.We herein experienced that a cause of arytenoid mucosal edema due to LC. This case was a 3-year-old girl. Her chief complaint was stridor and dyspnea. We observed her arytenoid mucosal edema and motion, such as the pendulum motion using a laryngeal endoscope. We considered that the potential causes of the arytenoid mucosal edema were allergy, laryngopharyngeal reflect disease（LPRD）and laryngomalacia. However, the arytenoid mucosal edema persisted after surgery. During the 4th operation, we noticed a LC. The patient currently does not have increased mucosal swelling, and is not suffering from aspiration and stridor.Type I LCs are largely undiagnosed in children. The diagnosis and management of LC is often delayed because it is difficult to diagnose LC. The diagnosis of LC must be made with the laryngoscope.

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