CHRISTOPHER PERRY, MBBS(QLD)

BRISBANE, AUSTRALIA

Laryngomalacia, the commonest cause of neonatal stridor, is not necessarily benign and self-limiting. The condition can occur at any age and be life-threatening. There are 3 basic pathologies causing the inspiratory supraglottic collapse: 1) floppy epiglottic cartilage (rare); 2) tight aryepiglottic folds or, rarely, lateral pharyngoepiglottic folds, pulling the epiglottis downward and backward; and 3) tall-standing, loose tubular supraglottic tissues. There is a definite place for surgery with acceptable complications, despite the novelty of these operative procedures. These operations are also of 3 types: 1) epiglottolinguopexy; 2) division of tight folds to allow a freestanding epiglottis; and 3) removal of loose supraglottic tissues. The type 2 procedure usually also requires a type 3 procedure at the same time, as the posterior flap of a tight aryepiglottic fold often prolapses forward on inspiration and needs removal or tightening. Surgery is indicated if respiratory distress interferes with adequate nutrition.