Around 5% of all infants are born with laryngomalacia and the vast majority spontaneously recover before two years of age. Up to 20% have associated anomalies. Potential complications requiring intervention include:, failure to thrive, hypoxia or hypercapnia, respiratory distress, pulmonary hypertension, aspiration and obstructive sleep apnea. Interventions may include positive pressure ventilation (invasive or non-invasive), tube feeding or surgical correction. We present our experience of 2 cases of severe laryngomalacia requiring surgical intervention. An otherwise well child with vomiting and failure to thrive and a second child with trisomy 21 with multiple anomalies. We demonstrate the complexity of differing presentations of laryngomalacia as well as the challenges of multi-disciplinary treatment. Supraglottoplasty involving division of the aryepiglottic fold and partial excision of the arytenoid mucosa was performed. The procedure does not need assisted ventilation after surgery and the recovery is very quick. Symptoms completely resolved in one case and respiratory support was discontinued in the second. The need for follow-up care including polysomnography is discussed.
