Epiglotic Anomaly Yields Reduced Airway Protection in an Infant

Proper laryngeal anatomy is crucial for airway protection. Congenital malformations of the airway are one cause of respiratory distress in children. An almost 5 month old male presented with increased work of breathing and worsening cough. Laryngoscopy showed the entire lingual surface of the epiglottis was tethered/compressed/grown to the base of tongue and was curled into a slight omega-shape. The arytenoid cartilages also hooded the glottis. The patient had airway collapse and did not have any visible tracheal rings consistent with severe tracheomalacia. A wedge-sling combination for sleeping, continuation of reflux medications, and follow up with the nutrition and feeding team were recommended. Direct laryngoscopy follow-up, sixteen months later, revealed floppy shortened epiglottis with more disconnect between the base of tongue and epiglottis. Moderate tracheomalacia with posterior collapse and right mainstem lateral collapse was also noted, with nearly complete resolution of his symptoms.