الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Laryngomalacia is the most common cause of stridor in infancy ranging from 60 -70% of all laryngeal anomalies .It presents in the first few weeks of life by inspiratory stridor that ranging from mild forms that does not affect growth and resolve spontaneously by age or severe forms with cyanosis and apneic attacks and failure to thrive that require medical or even surgical interventions in the form of either supraglottoplasty or tracheostomy in some cases. Diagnosis is made by direct visualization of the larynx during respiration by either flexible fiberoptic laryngoscope (FFL) or flexible fiber optic bronchoscope (FFB) or by direct laryngoscopy (DL) under general anesthesia supraglottic collapse is pathognomonic. Several comorbidities are met with laryngomalacia as reflux, cardiovascular anomalies and associated airway anomalies, central nervous system anomalies and genetic abnormalities.
This study was designed to review clinical presentations, managements and prognosis of infants suffering from laryngomalacia and associated congenital malformations. The current study included 182 cases of laryngomalacia cases diagnosed by FFL (54 cases), FFB (122 cases) and DL (6 cases).They were divided into two groups: group A prospectively studied laryngomalacia cases (24 cases) their age of onset ranged from (1-60 days) and group B retrospectively studied laryngomalacia cases (158 cases) their age of onset ranged from (1-30 days). Each patient was subjected to a full history taking and a full ENT examination and examination either by laryngoscope or bronchoscope for definitive diagnosis of laryngomalacia and further investigations were done to detect associated anomalies as echocardiography or karyotype, CT angiogram for chest and barium swallow study for selected cases. The data collected were statistically analyzed.
There were no statistical difference between group A and B as regards sex but there were female predominance M: F ratio 1:1.7 but males were more severe forms and needed surgical interventions more than females.
Our study showed that there was no effect of prematurity or NICU incubation on the severity of cases. Feeding difficulty was one of the presenting symptoms (30.2%) that ranged from mild reflux to more severe forms that affect infant growth till some cases had poor weight gaining and FTT. Cyanosis and apneic attacks also were one of the presenting symptoms (14.3%). In our study comorbidities with laryngomalacia were in the form of GERD (73.6%), air way anomalies (11%), CVS anomalies (8.8%), CNS anomalies (14%) and chromosomal anomalies (2%). We used a step wise management in dealing with cases in the form of lifestyle and dietary measures (29.7%) then anti-reflux medications for moderate cases (59.5%) and Surgery was done for severe cases (10.4%) in the form of supraglottoplasty either by laser (12 cases) or microlaryngeal instrument (2 cases) that was designed to remove excessive or redundant mucosa over arytenoids and aryepiglottic fold splitting or lysis. Some cases needed urgent intervention in the form of tracheostomy (5 cases). In our study only two cases had complication in the form of persistence of stridor and supraglottic stenosis. The latter case needed a revision surgery at age of 3 years. The stepwise approach was already used in the department so it was evaluated prospectively and retrospectively.