A Retrospective Study of Outcomes of Surgical Management of Severe Laryngomalacia

Background: Laryngomalacia is the most common cause of congenital stridor in infants. While most cases are mild and self-limiting, some develop severe disease requiring surgical intervention due to airway obstruction, feeding difficulties, or failure to thrive. This study evaluates the outcomes of surgical management for severe laryngomalacia at a tertiary care pediatric center. Methods: A retrospective review was conducted of 56 children with severe laryngomalacia who underwent surgery between January 2013 and January 2023. Patients with secondary airway lesions or significant comorbidities were excluded. Laryngotracheobronchoscopy findings classified patients into type 1-3 or combined types. Surgical interventions included aryepiglottoplasty, epiglottopexy, and resection of the arytenoid mucosa, performed using conventional cold steel techniques. Postoperative outcomes assessed included relief from stridor, extubation timing, need for second intervention or tracheostomy, and complications. Statistical analysis identified factors associated with outcomes. Results: The mean age was 3.67 ± 5.03 months; 58.9% were males. Type 2 laryngomalacia was most common (41.1%). Aryepiglottoplasty was the primary procedure in 41.8% of cases. Postoperatively, 80.4% achieved relief from stridor, 67.9% were extubated within 24 hours, and 14.3% required a second intervention. Tracheostomy was performed in 5.4% of patients, all with type 3 laryngomalacia. Younger age and absence of failure to thrive were significantly associated with favorable outcomes (p < 0.05). Delayed extubation and second interventions were more frequent in older infants and those with failure to thrive. No intraoperative or postoperative complications were observed. Conclusion: Surgical management of severe laryngomalacia is safe and effective, with high success rates and minimal morbidity. Early intervention and absence of failure to thrive predict better outcomes, while type 3 laryngomalacia is a strong predictor for tracheostomy. Individualized anatomical assessment remains crucial for optimal surgical planning.