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ORIGINAL ARTICLE

O NLINE F IRST

A Systematic Review of Supraglottoplasty Outcomes

Diego Preciado, MD, PhD; George Zalzal, MD

Objectives : To analyze the available published data on supraglottoplasty, epiglottoplasty, and laryngomalacia and to evaluate the relative risk of supraglottoplasty failure. Design : Systematic review with determination of rela tive risk. Main Outcome Measures : A PubMed search was per formed with the following inclusion criteria: English lan guage, human subjects, supraglottoplasty, epiglotto plasty, and laryngomalacia. The results of the included studies were summarized and analyzed. Subgroup analy sis was then performed. Results : Twelve studies were identified, with 8 meet ing the inclusion criteria. The overall risk ratio of surgi cal failure among patients with associated comorbidi ties compared with those with isolated laryngomalacia

was 7.14 (k=6 studies; 95% CI, 3.73-13.74; P .001). The risk ratio for persistent or significant aspiration af ter supraglottoplasty among patients with associated co morbidities compared with those with isolated laryngo malacia was 4.33 (k=3 studies; 95% CI, 1.25-15.06; P = .02). Insufficient data were available to assess out come by age at surgery or specific technique used. Conclusions : The relative risk of supraglottoplasty fail ure is significantly higher among patients with associ atedmedical comorbidities. This aggregate finding should be taken into account when parents are counseled as to the expected surgical outcome of infants with laryngo malacia who are undergoing supraglottoplasty. Arch Otolaryngol Head Neck Surg. 2012;138(8):718-721. Published online July 16, 2012. doi:10.1001/archoto.2012.1251

L ARYNGOMALACIA IS THE MOST common congenital laryn geal cause of stridor, repre senting the diagnosis in ap proximately 45% to 75% of pediatric stridor cases. Surgical correc tion is reserved for severe cases that are accompanied by apneic spells, failure to thrive, and feeding difficulties, which in volve fewer than 10% of patients with the condition. Endoscopic supraglottoplasty is the current mainstay and first-line op eration for infants with severe laryngoma lacia. This procedure was first described by Zalzal et al 1 in 1987 using cold instru ments. Subsequently, the carbon dioxide laser became popular, and since then, the microdebrider has been introduced. 2,3 Re cent studies suggest that there is no dif ference in outcome between the 2 endo scopic instrumentation (laser vs cold steel) 4,5 techniques. Fortunately, supraglottoplasty is re markably successful in improving or re solving the symptoms and signs of laryn gomalacia in most patients. Reported success rates range from 53% to 95%. 1,6-9 While the details on the definition vary

from study to study, the success of supra glottoplasty rests on an improvement in respiratory status and feeding problems. Supraglottoplasty failures may be attrib utable to 1 of 2 main issues: (1) failure to resect enough supraglottic tissue or (2) co morbid conditions that contribute to the poor clinical picture. Complications re sulting from supraglottoplasty are also rare. In most series, the rate is below 10%. The most common postoperative long-term complication is aspiration, with others such as granuloma formation and supra glottic stenosis being quite rare. There also appears to be no difference in complica tions according to the endoscopic instru mentation used. 3-5,10 However, given the low rate of expected complications, most of these case series are underpowered to identify possible differences by patient group or between techniques. The goals of this study were to combine the reported outcome literature on supra glottoplasty and to performa systematic re view of supraglottoplasty outcomes. In do ing so, we aimed to determine the relative risk of failure of the procedure from the available published aggregate data.

Author Affiliations: Division of Otolaryngology, Children’s National Medical Center, Washington, DC.

ARCH OTOLARYNGOL HEAD NECK SURG/ VOL 138 (NO. 8), AUG 2012 WWW.ARCHOTO.COM 718

©2012 American Medical Association. All rights reserved.

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