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Original Article
June 2001

Unilateral vs Bilateral Supraglottoplasty for Severe Laryngomalacia in Children

Author Affiliations

From the Department of Otolaryngology–Head and Neck Surgery, Indiana University School of Medicine, Indianapolis. Dr Reddy is now with the Department of Otolaryngology–Head and Neck Surgery, University of Michigan School of Medicine, Ann Arbor.

Arch Otolaryngol Head Neck Surg. 2001;127(6):694-699. doi:10.1001/archotol.127.6.694

Objectives  To study the efficacy of unilateral supraglottoplasty in comparison with bilateral supraglottoplasty for the treatment of severe laryngomalacia in children and to study factors that may be predictive of major complications or the need for a subsequent contralateral or revision procedure.

Design  Retrospective medical record review.

Setting  University tertiary care pediatric hospital.

Patients  One hundred six consecutive pediatric patients, aged 9 days to 18 years, who had undergone unilateral or bilateral supraglottoplasty for severe laryngomalacia.

Main Outcome Measures  Resolution of clinically significant laryngomalacia, development of major complications (supraglottic stenosis or aspiration), and an association between study variables (demographics, medical comorbidities, synchronous airway abnormalities, sites of excision, and techniques of excision) and the need for subsequent contralateral or revision supraglottoplasty.

Results  We achieved a high success rate (95.7%), a low complication rate (8.5%), and observed the need for a contralateral procedure in 7 (14.9%) of the 47 patients who underwent initial unilateral supraglottoplasty. Two patients who underwent initial bilateral supraglottoplasty developed supraglottic stenosis. No significant association existed between our study variables and the development of complications or the need for contralateral or revision supraglottoplasty.

Conclusions  Unilateral supraglottoplasty was associated with a high success rate, low complication rate, and the avoidance of supraglottic stenosis in our study population. The percentage of patients requiring a subsequent contralateral procedure was comparable to that reported in the literature, and no major complications were associated with the second operation in these patients. Therefore, unilateral supraglottoplasty seems to be a reasonable option for initial surgical management of pediatric patients with severe laryngomalacia.