gms | German Medical Science

Introduction: Supraglottoplasty is the gold standard for treatment of severe laryngomalacia. The surgical tools used in this type of intervention range from cold steel and microdebriders to different types of lasers. We propose and outline a surgical protocol for supraglottoplasty in a laryngomalacia type II case, performed using a harmonic scalpel.

Materials and methods: An otherwise healthy male infant was referred to the ENT department at “St. Marina” University Hospital - Varna, Bulgaria with a history of stridor since birth. Clinically larygomalacia was diagnosed by means of sleep endoscopy and subsequently corrected with supraglottoplasty at the age of 23 months. General trans-nasal intubational anaesthesia was used for the procedure. The performing surgeon held both the MacIntosh direct laryngoscope and the Harmonic scalpel, while the assistant held a rigid endoscope. Postoperatively the child was transferred to the children’s and neonatal intensive care unit for constant monitoring for a period of 24 hours.

Results: The described surgical protocol was carried out with ease by a team of two ENT surgeons in a child of this age and rate of development. The Harmonic scalpel allowed for an effective and bloodless division of the aryepiglottic folds with up to two applications. The leading symptoms resolved postoperatively. Three months postoperatively a control sleep endoscopy was performed and showed improved anatomical relations of the laryngeal complex and a widened laryngeal aperture with no signs of scarring at the resected aryepiglottic folds.

Conclusions: The use of harmonic scalpel surgery for the treatment of laryngomalacia appears to be a practical, affordable and easily applicable alternative to the already established surgical protocols.

Supported by: This research received no specific grants nor funding from any agency, commercial or not-for-profit organizations.

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