Laser Epiglottopexy: Flexible versus Line-of-Sight Technique

Objective: Determine outcomes in children with epiglottic laryngomalacia treated with laser (CO2, LISA) epiglottopexy by both flexible (photonic band gap technology) and traditional direct line-of-sight techniques. These procedures are used as a monotherapy for the treatment of obstructive sleep apnea resulting from epiglottic retroflexion or sagittal collapse.

Method: Single center, retrospective review of patients with epiglottic laryngomalacia treated with laser epiglottopexy from 2005 to 2010. Outcomes measured include sex, age, gestational age, primary obstructive sleep apnea presentation, type of dynamic epiglottic collapse, polysomnogram information, medical comorbidities, and resolution of symptoms after surgery.

Results: Five cases were reviewed; 80% male, 20% female. The average age at treatment was 9.4 years. All patients had underlying medical comorbidities (Turner Syndrome, Bardet-Biedl, etc). Various initial presentations include (can be more than one): 80% sleep disturbance, 80% apneic episodes, 20% cyanosis, and 20% snoring. A total of 80% had epiglottic retroflexion as the primary anatomic dilemma, with only one having sagittal collapse. Average AHI was 23.8. All received laser epiglottopexy (3 flexible laser, 2 line-of-sight). All but one received concomitant tacking sutures. Average operative time was 150 min. Average hospital stay was 5.2 days. All had symptom resolution at 135 days of average follow-up.

Conclusion: Laser epiglottopexy, using either flexible technology or line-of-sight method, can be done safely, efficiently, and effectively as monotherapy for obstructive sleep apnea caused by epiglottic collapse. Advances in this technology and in these techniques may prove helpful not only in this specific problem, but for the treatment of laryngomalacia in general.