Laryngeal surgery in children

Abstract

Laryngeal surgery in children is different from laryngeal surgery in adults and optimally requires a specialized team or staff dedicated to the treatment of children. The anesthesiological approach is related to the age of the patient and is of decisive importance. Maturation of the vocal folds is a delicate process, and superficial and intermediate layers are well defined with a mature vocal ligament by age 16. Congenital or acquired cysts are mostly supraglottic retention cysts. Neonates who have been intubated for a long time can have difficulties with detubation due to intubation granulomas. Congenital laryngeal webs and laryngeal atresia cause stridor. However, smaller webs cause hoarseness and breathiness. Subglottic hemangiomas progressively obstruct the airway within the first few months of life. In rare cases, stridor is due to congenital laryngeal paralysis, which may be unilateral or bilateral. It can worsen during infancy but may be well tolerated even when bilateral. Juvenile onset of recurrent laryngeal papillomas is rare but may be suspected in conjunction with progressive dysphonia. Papillomatosis is exceptional before the age of 1 year. Sulcus glottidis in children seems to be a congenital lesion that deteriorates with increasing age. Vocal abuse is frequent in children. The important question is whether the voice problem is the child's problem. Gastroesophageal reflux (GER) may cause roughness. The precise pathogenetic role of laryngopharyngeal reflux has not yet been established. The preoperative assessment in patients presenting with stridor is important. Progressive stridor in infants, degree of suprasternal retraction, and failure to thrive are elements that lead to the decision for performing endoscopy under general anesthesia. Some give antacids at least for as long as stridor is not controlled and/or appropriate surgical treatment has not been performed. © Springer-Verlag Berlin Heidelberg 2010.