1. Background

• due to a congenital weakness of the aryepiglottic folds and epiglottis which are sucked into the airway during inspiration
• embryologic origin of defect unknown
• a self-resolving disorder as cartilagenous development will eventually support the affected structures
• when a similar process involves the:
  • trachea - tracheomalacia
  • bronchus - congenital lobar emphysema

1. Larynx

• malformation of the laryngeal cartilage (vocal cords)
• juvenile larygneal papillomatosis
• severe chondromalacia of larynx and trachea

2. Luminal Obstruction

• laryngeal web
• laryngeal hemangioma
• cysts - mucous retention cysts, brachial cleft cysts
• thyroglossal duct remnants
• lymphangioma
• congenital goiters
• vascular anomalies

3. Others

• Pierre Robin Syndrome
• hypoplasia of the mandible
• macroglossia

1. Congenital Stridor

• begins within the first few days of life or up to 2 months (but not at birth)
• louder on inspiration
• worse with crying, upper respiratory tract infections (URTI), supine position with neck flexed
• better in prone position with neck hyperextended
• may be accompanied by:
  • significant inspiratory retractions
  • normal voice -> hoarseness, aphonia, or laryngeal "crow"
• may worsen over the first few months of life before improving

2. Complications

• respiratory distress with dyspnea
• thoracic deformities (if retractions severe)
• failure to thrive (if difficulty nursing)
• tracheostomy (0.3%)
• long-term inspiratory stridor with URTI, exertion, and/or crying throughout childhood

1. Direct Laryngoscopy

• diagnostic

1. Supportive

• respiratory support with severe or life-threatening upper airway obstruction, i.e., intubation, tracheostomy
• feeding difficulties
  • slow and careful feedings
  • may use dropper or gavage feedings

2. Surgery

• surgical repair in severe cases

3. Prognosis

• natural history is worsening in the first few months of life with improvement at about 12 months with resolution by 18 months

The Virtual Hospital - Tracheo/Laryngomalacia