Laryngomalacia, or noisy breathing in infants, is the most common reason for a newborn to have stridor, or noisy breathing. The stridor is typically inspiratory, and is worse when the baby is on its back. Laryngomalacia is characterized by an omega shaped epiglottis, short aryepiglottic folds, and redundant mucosa of the arytenoids. Surgery is indicated when the stridor is severe enough to impact breathing or when the baby is not gaining weight due to this issue. Surgery is relatively simple and first involves a bronchoscopy, or an evaluation of the lower airways, to make sure nothing else can be the root cause of these issues. Palpation for a laryngeal cleft is also performed. Once it is determined that laryngomalacia is the primary etiology, the aryepiglottic folds are incised with microscissors and redundant mucosa of the arytenoids is trimmed. Patients usually do very well after this procedure, and if there are no other problems, are able to breathe well and gain weight. For more information, go to: https://www.mountsinai.org/care/ent/services/pediatric
Aldo V. Londino III, MD Assistant Professor, Otolaryngology Mount Sinai Health System
Michael A. Rothschild, MD Professor, Otolaryngology Mount Sinai Health System
Mark S. Courey, MD Chief, Division of Laryngology Director, Grabscheid Voice and Swallowing Center of Mount Sinai Vice Chair of Quality, Department of Otolaryngology Mount Sinai Health System
Diana N. Kirke, MD Assistant Professor, Otolaryngology, Head and Neck Surgery The Mount Sinai Hospital
Matthew C. Mori, MD Assistant Professor, Otolaryngology New York Eye & Ear Infirmary of Mount Sinai
Zachary G. Schwam, MD Assistant Professor, Department of Otolaryngology-Head and Neck Surgery Division of Otology-Neurotology, Lateral Skull Base Surgery Mount Sinai Health System The Mount Sinai Oology Surgical video series presents pediatric superlotto blast and bronchoscopy for laryngomalacia or noisy breathing. This video is performed by our department, pediatric Oto laryngologist, as well as laryngologist. This video was edited by Zachary Swam. Here we have the initial view of the larynx of a child with laryngomalacia or a floppy upper airway. The hallmark findings include an omega shaped epiglottis, short a epiglottic or a E folds and redundant mucosa over the arino cartilages. All of these contribute to inspiratory strider and may cause respiratory distress or failure to thrive. The endoscope is advanced further into the airway where one can see the vocal folds in the surrounding anatomy as the camera makes its way down the trachea. One can see the tracheal muscle posteriorly. The Corina is as far as we will go and one can see the split into the right and left main stem bronchi. This is a normal exam, an angled probe is used to palpate the intra rino notch which looks relatively deep. However, it is not felt to represent a true laryngeal cleft. The operative plan for the super glode plasty is outlined the A e folds will be released along the white dash lines. And the blue circles represent areas where redundant mucosa will be denuded from the arino an endotracheal tube has been placed in the meanwhile, using external pressure, the larynx can be manipulated left and right to create tension on the A E folds. This makes the incisions much easier. A laryngeal scissor is used to make a series of snips in the A E fold to release it. The same is done for the right side. This is the same patient now being viewed with an operative microscope. This allows the surgeon to use their left hand to grab tissue and retract it, creating better counter tension. The right eight E fold is released a bit more next, the mucosa over the right ariti noid is grabbed and resected with a scissor. It is critical to leave a layer of perichondrium over the cartilage. The same procedure is performed on the left ariti noid. Finally, we inject a small volume of carboxymethyl cellulose filler into the intra rino notch. Laryngeal retractors have been placed to spread the vocal folds and create tension. A special laryngeal injection needle is placed and a small volume of filler used. It is critical not to over inject as you can cause respiratory compromise.