Surgical treatment of congenital laryngeal malformations

Congenital malformations of the larynx are relatively scarce, but may be life threatening. The most common causes include laryngomalacia, vocal cord paralysis, and subglottic stenosis. The last 20 years have seen major advances in the field of surgical correction of such anomalies, also serving to reduce the number of tracheotomies in children and the inherent dangers they pose. Success rates for the most popular surgical procedures have been favorable. These include supraglottoplasty for cases of severe laryngomalcia, where relief of respiratory symptoms has been shown to occur in excess of 80% of cases. Complication rate is low, although postoperative death has been reported. Failure usually occurs in cases with concomitant airway abnormalities, including pharyngomalacia. Vocal cord lateralization for vocal cord paralysis with airway compromise is achieved by means of arytenoidopexy or arytenoidectomy using the lateral approach. Arytenoidectomy can also be performed using laryngofissure or endoscopic laser excision. Subglottic stenosis is the third most common congenital anomaly. Anterior or multiple cricoid splitting with cartilage graft interpositioning is usually performed. Success rates for these procedures have been shown to be around 90%.