What is Supraglottoplasty?
Supraglottoplasty is a microscopic surgical procedure used primarily for the treatment of Laryngomalacia. Supraglottoplasty is a surgical procedure in which the malformed and distorted structures of the larynx are altered. Laryngomalacia is a congenital infancy disease in which laryngeal cartilage becomes soft and floppy. This floppy laryngeal cartilage then falls and collapses with the airway opening during inspiration, causing the airway’s partial obstruction, which results in the stridor, noisy breathing. During the Supraglottoplasty, these obstruction causing tissues are either removed or altered to ease breathing and provide a stable pathway for the air. Only the required amount of tissue is removed without compromising the function of the airway.
There are various supraglottic structures affected in Laryngomalacia, based on which there are different Supraglottoplasty techniques. The different types of Laryngomalacia are given below:
In type 1, the arytenoid cartilages collapse inward.
In type 2, the aryepiglottic folds undergo medial displacement.
In type 3, the epiglottis undergoes posterior caudal displacement against the pharyngeal wall.
Based on different types of Laryngomalacia, the various techniques of Supraglottoplasty are given below:
- The type 1 Supraglottoplasty requires the removal of redundant supra-arytenoid tissues.
- In type 2 Supraglottoplasty, an incision is made to decrease the aryepiglottic folds.
- In type 3 Supraglottoplasty, the epiglottopexy surgery is done. In this surgery, the epiglottis is permanently fixed with the aryepiglottic folds.
The recovery after the Supraglottoplasty requires the monitoring of the patient overnight. The patient is kept in the Intensive Care Unit, where he is extubated and monitored. In sporadic cases, the patient is kept intubated to let the airways heal for a day. The patient is given adequate and appropriate analgesic to relieve the pain. The patient cannot aspire after the Supraglottoplasty; therefore, the air should be humidified, and the patient should be given anti-reflux medicines. To reduce the post-op swelling and edema, the patient is usually prescribed steroids such as Dexamethasone. Following the surgery, the patient often sounds worse, and some time has feeding difficulty; this condition takes one to two weeks to recover. The patient needs some time to get used to feeding and breathing. The recovery after the Supraglottoplasty usually requires two weeks.
In case of severe laryngomalacia or severe obstruction, surgical procedures have opted. The symptoms of severe laryngomalacia include noisy breathing, airway distress, and difficulty in feeding. The surgery is usually done through the mouth. It usually takes 30 minutes. The patient is first given anesthesia through both inhalation and intravenous routes. Then the evaluation of the airway is done through rigid endoscopy.
The rigid Indus copy is done to eliminate the secondary lesions of glottis and trachea. The primary area of the collapse of laryngeal cartilage is noted through the visualization of supraglottis during unprompted respiration. The larynx is open with the help of operating laryngoscopes. After the opening of the larynx, the Supraglottoplasty is performed. The superfluous arytenoid tissues are removed. The surgical procedure is done according to the patient’s need and its area of obstruction.
Great care is taken to avoid the areas which have a risk of supraglottic stenosis. Supraglottoplasty has fewer complications. The success rate of Supraglottoplasty has an estimation of 94%. The 19 to 45 % patient requires an additional tracheostomy. Mostly it is done in patients who fail to recover after Supraglottoplasty and still have life-threatening obstruction of airways.
There are many complications associated with Supraglottoplasty. Supraglottoplasty can cause potential long-term complications. Patients with congenital abnormalities face more frequent complications with Supraglottoplasty than others. Aspiration is one of the significant complications of Supraglottoplasty. This is particularly common with patients who have neurological variants of Laryngomalacia.
The Supraglottoplasty complications also include persistent sleep apnea, dyspnea, and airway fires. It also causes long-term laryngeal cartilage damage. Patients fail to thrive. It also produces edema. The excessive removal of supraglottic tissues causes supraglottic scarring and fibrosis. One of the Potential long term complications of the Supraglottoplasty is the supraglottic stenosis. The Supraglottoplasty Also produces granulomas. It can also lead to death. In the case of high-risk Supraglottoplasty, the surgeons often recommend Unilateral Supraglottoplasty.
The unilateral Supraglottoplasty has fewer side effects than other ones. Although good outcomes are achieved with unilateral Supraglottoplasty, still sometimes patients have to undergo subsequent contralateral procedures. In the case of surgical failure, the most frequently reported complications of supraglottoplasty are airway distress, persistent laryngomalacia, and the requirement for tracheostomy.