Complications

Complication
Timeframe
Likelihood
short term
high

GERD is reported in 50% to 100% of patients with laryngomalacia (LM).[1][7][15][48]

Reflux causes laryngeal mucosal inflammation and edema with narrowing and increased obstruction leading to LM. This in turn increases negative intrathoracic pressure, which exacerbates GERD.[17]

short term
low

Occurs very rarely. More likely in cases with synchronous airway lesions or when additional sources of acute airway compromise are present (e.g., infection). Intubation may be required in the most severe instances.

long term
low

Complications include granulomas, synechiae, aspiration, and supraglottic stenosis.[36][43]

Supraglottic stenosis occurs following 2% to 4% of supraglottoplasty procedures.[36][43]

Difficult to treat and occurs more commonly after repeated procedures or surgery with aggressive mucosal resection, particularly involving the interarytenoid region; use of unilateral supraglottoplasty may reduce the risk.

variable
medium

May result from feeding difficulties secondary to upper airway obstruction.

Surgical treatment with endoscopic supraglottoplasty may be required.

variable
medium

May result from feeding difficulties secondary to upper airway obstruction.

Aspiration may also occur postsurgery with episodes of laryngeal penetration occurring. Usually transient and often unrecognized. Aspiration may rarely persist long term, most commonly in patients with coexisting neurologic conditions and poor laryngeal tone. Recurrent episodes of aspiration may occur, leading to irreversible injury to the lungs with subsequent poor gas-exchange and respiratory function.

variable
medium

Substantial potential for short- and long-term morbidity with tracheostomy, including a tracheostomy-related mortality rate of about 2%.[47]

variable
low

Infants with LM who have hypoxemia have been found to more readily develop pulmonary hypertension/cor pulmonale.[49]

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