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Original Investigation |

Visualization of the Supraglottis in Laryngomalacia With 3-Dimensional Pediatric Endoscopy

Philip Gaudreau, MD, LCDR, MC, USN1,2; M. Taylor Fordham, MD3; Tiffany Dong, BA4; Xinyang Liu, PhD2; Sukryool Kang, PhD2; Diego Preciado, MD, PhD2; Brian K. Reilly, MD2
[+] Author Affiliations
1Department of Otolaryngology, Naval Medical Center, San Diego, California
2Division of Otolaryngology, Children’s National Medical Center, Washington, DC
3Division of Otolaryngology, Baylor College of Medicine, San Antonio, Texas
4currently a medical student at George Washington University School of Medicine, Washington, DC
JAMA Otolaryngol Head Neck Surg. 2016;142(3):258-262. doi:10.1001/jamaoto.2015.3370.
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Importance  The use of 3-dimensional (3D) endoscopy has been described in the pediatric airway and has been shown to improve visualization of complex airway anatomy. Laryngomalacia is one of the most common airway disorders evaluated in pediatric otolaryngology offices. Whether 3D visualization is superior to standard endoscopy as a means for assessment and surgical management of complex airway anatomy is unclear.

Objective  To describe a pilot case series using 3D endoscopy to facilitate supraglottoplasty and to assess surgical outcomes.

Design, Setting, and Participants  A prospective case series was conducted of 11 children undergoing supraglottoplasty from July 1, 2010, to June 31, 2014, at a tertiary care pediatric hospital. Infants and children with symptomatic laryngomalacia were eligible for the study. Follow-up was completed on December 31, 2014, and data were assessed from February 1 to 15, 2015.

Interventions  Supraglottoplasty performed using 3D endoscopy.

Main Outcomes and Measures  The outcome data collected included length of hospital stay and frequency of complications (ie, aspiration, granuloma formation, supraglottic narrowing, revision surgery, tracheostomy, and gastrostomy).

Results  Eleven children were treated for laryngomalacia with supraglottoplasty (6 boys and 5 girls; mean [SD] age, 29 [85] months). Four of these children (36%) also had grade I subglottic stenosis. The 3D endoscope was judged by all participating senior surgeons to improve visualization of the supraglottic anatomy and to permit more precise tissue removal. No complications occurred after the surgery. Hospital stay was found to be an unreliable indicator owing to multiple comorbidities in many children. Worsening of aspiration occurred in 1 child (9%) who subsequently required gastrostomy tube placement. This child demonstrated progressive neurologic impairment and had severe hypotonia and developmental delay. Another child with subglottic stenosis and subglottic cysts required a tracheostomy owing to severe rhinovirus tracheitis. The remaining 9 children (82%) had good outcomes, with a mean follow-up of 14.7 (range, 12-24) months.

Conclusions and Relevance  The anatomy of the supraglottis in laryngomalacia is better visualized using 3D techniques. Use of 3D endoscopy may allow for more precise tissue removal. The outcomes and complication rates are similar to those of standard 2D techniques. This study provides a platform to begin comparative analysis between 3D and standard 2D techniques.

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Figure 1.
The Supraglottis in a Patient With Severe Laryngomalacia

Endoscopic views compare 2- and 3-dimensional (3D) technology. Red-cyan glasses are recommended for viewing the 3D image.

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Figure 2.
Supraglottis After Incising the Aryepiglottic Folds During Supraglottoplasty

Three-dimensional (3D) endoscopic images are shown during supraglottoplasty. Red-cyan glasses are recommended for viewing the 3D image.

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Figure 3.
Supraglottis After Removal of Redundant Arytenoid Mucosa

Three-dimensional (3D) endoscopic images are shown during supraglottoplasty. Red-cyan glasses are recommended for viewing the 3D image.

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Figure 4.
Supraglottis With a Widely Patent Airway

Three-dimensional (3D) endoscopic images are shown after supraglottoplasty. Red-cyan glasses are recommended for viewing the 3D image.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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Three-Dimensional Supraglottoplasty Technique

This video demonstrates the visualization achieved and technique used to perform supraglottoplasty using the 3-dimensional endoscope. Red-cyan glasses are recommended for viewing.

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