Histopathology of laryngomalacia

Abstract

Background

Laryngomalacia is the commonest laryngeal anomaly and cause of stridor in children. Although most cases are self-limiting, failure to thrive, hypoxaemia or significant apnoeic episodes may warrant surgical intervention in the form of aryepiglottoplasty. Opinion is divided as to the pathophysiological mechanisms involved in the disease process.

Aims and objectives

This study explores the aetiology of laryngomalacia by reviewing the histology of aryepiglottoplasty resection specimens.

Material and Methods

The histology reports of 61 aryepiglottoplasty specimens resected between 1 October 2014 and 31 October 2018 were reviewed.

Results

Age of patients ranged from 3 weeks to 36 months. 36 patients were male and 25 female. 43 of 61 (70.5%) cases had inflammation, most of which were mild. 3 (4.9%) cases had histological specimens with detectable eosinophils. None of the specimens had signs of granulomatous change, ulceration or calcification. Cartilage was present in the resected specimen in 47 (77%) cases. Over half of these (59.6%) were immature cartilage.

Conclusion and Significance

The results suggest a mild concurrent laryngitis/supraglottitis in most cases. Eosinophilia is rare and does not support eosinophilic oesophageal reflux as part of the aetiology. The high proportion of immature cartilage in the specimens supports the theory of chondropathic aetiology.

Chinese abstract

背景：喉头软化症是儿童最常见的喉头异常和喘鸣原因。尽管大多数情况是自限性的, 但因发育阻滞、低氧血症或严重的气喘病发作, 可能需要以鼻咽成形术的形式进行手术干预。关于该疾病过程中涉及的病理生理机制存在意见分歧。

目的：本研究通过研究鼻咽成形术切除标本的组织学特征来探讨喉头软化的病因。

材料和方法：回顾了在2014年10月和2018年10月31日期间的61例鼻咽成形术切除标本的组织学报告。

结果：患者年龄从3周到36个月不等。男36例, 女25例。 61例中的43例（70.5％）有炎症, 大多为轻度。 3例（4.9％）的组织学标本含有可检测到的嗜酸性粒细胞。标本均无肉芽肿改变、溃疡或钙化迹象。 47例（77％）切除的标本中存在软骨。一半多（59.6％）是未成熟的软骨。

结论和意义：研究结果表明, 大多数病例患有轻度并发性喉炎/声门上炎。嗜酸性粒细胞增多是罕见的, 它不支持嗜酸性食管反流是病因的一部分。标本中未成熟软骨的比例很高, 支持了软骨病的病因学理论。

Keywords:

• Laryngomalacia
• stridor

Disclosure statement

No potential conflict of interest was reported by the author(s).