Supraglottoplasty
Supraglottoplasty is surgery to remove or reshape the tissues of your upper larynx. Surgeons commonly use supraglottoplasty to treat laryngomalacia — a condition that causes noisy breathing in babies. Supraglottoplasty boasts impressive success rates, from 70% to 100%. The procedure can greatly improve your child’s quality of life.
Supraglottoplasty is a surgery that removes excess tissue from your larynx (voice box). This prevents the tissue from falling back over your airway and interfering with breathing.
Surgeons usually do supraglottoplasty on infants, but sometimes older children and adults need it, too. Healthcare providers usually only recommend it when nonsurgical treatments haven’t worked. Overall, supraglottoplasty is safe, quick and effective. You (or your baby) should be able to resume normal routines in a couple of weeks.
Surgeons commonly use supraglottoplasty to treat laryngomalacia. Babies with laryngomalacia have floppy tissue around their voice boxes that falls back over their airways. Supraglottoplasty surgery removes or reshapes the tissue to improve breathing. Laryngomalacia doesn’t always require surgery, but about 20% of babies with the condition will need it.
Less commonly, healthcare providers use supraglottoplasty to treat obstructive sleep apnea (OSA) in both children and adults.
Supraglottoplasty doesn’t require a lot of preparation. But if you have acid reflux, your surgeon might prescribe medication for you to take a few days before surgery. This can help avoid reflux-related complications.
Your surgeon may also order a swallow study. This imaging test ensures that you’re swallowing normally.
You’ll probably need to avoid foods and beverages for several hours before the procedure. Your healthcare provider will give you a list of presurgical guidelines specific to your situation.
Healthcare providers do supraglottoplasty in a hospital under general anesthesia. They might use traditional surgical instruments or laser therapy to do it. Your provider can tell you which option is best for your situation.
You can expect the following steps during supraglottoplasty:
- An anesthesiologist gives you anesthesia.
- A surgeon uses a laryngoscope to view your voice box. They’ll make cuts (incisions) across the aryepiglottic folds (triangular folds of mucus membrane) on both sides of your larynx.
- They’ll use tiny instruments to remove and reshape excess tissue.
- The surgeon will use gauze to control bleeding.
Supraglottoplasty surgery usually takes less than an hour. Though it’s a quick procedure, your baby will probably need to stay in the hospital overnight for observation.
The main benefit of supraglottoplasty is that it improves breathing. In babies with laryngomalacia, supraglottoplasty can also improve their ability to eat and sleep. These innate functions support your baby’s physical, emotional, mental and social development.
Some babies have such a hard time breathing that they end up burning more calories than usual, resulting in unwanted weight loss. Supraglottoplasty can correct this issue, too.
Researchers estimate that success rates for supraglottoplasty range from 70% to 100%. These success rates are lower in children with certain syndromes, neurological issues or heart conditions. In most situations, supraglottoplasty can greatly improve your child’s quality of life.
Overall, supraglottoplasty is a safe procedure with predictable outcomes. But like any surgery, there are still risks.
Complications after supraglottoplasty may include:
- Aspiration (inhaling liquid or food into the airway).
- Blood clots.
- Continued breathing issues.
- Damage to surrounding structures.
- Difficulty swallowing.
- Excessive bleeding.
- Infection.
Your healthcare provider will monitor your child to make sure they’re healing as expected. An overnight hospital stay ensures that your healthcare team is there to help if complications occur.
Supraglottoplasty recovery time usually lasts one to two weeks. But this varies depending on the severity of your baby’s condition and the extent of surgery.
Your baby will probably have some degree of swelling and discomfort, especially during the first few days. Their breathing might even sound worse than it did before surgery, and they might have feeding difficulties. These things are normal (and temporary) — and not a cause for concern. But if your child’s symptoms worsen or don’t improve after two weeks, let your healthcare provider know.
Your surgeon will give you a list of supraglottoplasty post-op care guidelines. Be sure to follow them closely. They’ll likely prescribe anti-reflux medications (like H2 blockers or proton pump inhibitors) to keep stomach acid from irritating your baby’s throat and windpipe. They’ll also prescribe pain relievers to keep your baby comfortable during their recovery.
The best thing you can do is give your child lots of TLC. Let them rest and be sure to give them their medications at the appropriate times. Remember, your healthcare provider is here to help if you have any questions or worries.
When should I call my healthcare provider?
Call your healthcare provider if your baby develops:
- An increase in noisy breathing after two weeks.
- Coughing when drinking liquids.
- Fever.
- Pain that doesn’t go away with medication.
- Shortness of breath.
References
- Kang ES, Turkdogan S, Yeung JC. Disposition to pediatric intensive care unit post supraglottoplasty repair: a systematic review (https://pubmed.ncbi.nlm.nih.gov/37106398/). J Otolaryngol Head Neck Surg. 2023 Apr 27;52(1):35. Accessed 8/21/2024.
- Maksimoski M, Li C. Surgical Management of Pediatric Obstructive Sleep Apnea Beyond T&A – Tongue Base and Larynx (https://pubmed.ncbi.nlm.nih.gov/38538515/). Otolaryngol Clin North Am. 2024 Mar 26:S0030-6665(24)00034-3. Accessed 8/21/2024.
- Morse E, Pereira N, Liu K, Veler H, Maresh A. Management and outcomes of obstructive sleep apnea in infants (https://pubmed.ncbi.nlm.nih.gov/37075592/). Int J Pediatr Otorhinolaryngol. 2023 May;168:111558. Accessed 8/21/2024.
- Pu S, Xu H, Li X. Supraglottoplasty in neonates and infants: A radiofrequency ablation approach (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839815/). Medicine (Baltimore). 2018 Feb;97(7):e9850. Accessed 8/21/2024.
- van der Heijden M, Dikkers FG, Halmos GB. Treatment outcome of supraglottoplasty vs. wait-and-see policy in patients with laryngomalacia (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4858546/). Eur Arch Otorhinolaryngol. 2016 Jun;273(6):1507-13. Accessed 8/21/2024.
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