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Cricopharyngeal achalasia associated with laryngomalacia as a cause of failure to thrive

Published online by Cambridge University Press:  18 June 2018

V Givens ,
K Brent ,
M Dunham  and
S P Kanotra
V Givens
Affiliation:
Department of Otolaryngology, Louisiana State University, Children's Hospital New Orleans, USA
K Brent
Affiliation:
Department of Pediatric Gastroenterology, Louisiana State University, Children's Hospital New Orleans, USA
M Dunham
Affiliation:
Department of Otolaryngology, Louisiana State University, Children's Hospital New Orleans, USA
S P Kanotra*
Affiliation:
Department of Otolaryngology, Louisiana State University, Children's Hospital New Orleans, USA
*
Address for correspondence: Dr Sohit Paul Kanotra, Department of Pediatric Gastroenterology, Louisiana State University, Children's Hospital New Orleans, 200 Henry Clay Avenue Suite 4119, New Orleans, Louisiana 70118, USA Fax: +1 504 896 9296 E-mail: skanot@lsuhsc.edu
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Abstract

Objective

To describe a case of concurrent cricopharyngeal achalasia with laryngomalacia as a cause of failure to thrive, and to review the literature and management options of cricopharyngeal achalasia in the paediatric population.

Methods

A chart review was performed on a four-month-old male, referred for failure to thrive, and diagnosed with cricopharyngeal achalasia and laryngomalacia. A PubMed and Embase search for ‘cricopharyngeal achalasia’ and ‘laryngomalacia’ was conducted. A review of reported paediatric cricopharyngeal achalasia patients, with emphasis on management options, was undertaken.

Results

A flexible laryngoscopic examination confirmed the laryngomalacia diagnosis, and videofluoroscopic evaluation of swallowing demonstrated cricopharyngeal achalasia via a cricopharyngeal bar. Supraglottoplasty was performed, with botulinum toxin injection into the cricopharyngeus muscle, with resultant improvement in oral intake and resolution of failure to thrive. The literature review revealed no reported case of the combined pathologies as a cause of failure to thrive.

Conclusion

Functional endoscopic evaluation of swallowing and videofluoroscopic evaluation of swallowing are complimentary in the evaluation of paediatric patients with failure to thrive and suspected oropharyngeal dysphagia. Both supraglottoplasty and botulinum toxin injection are effective for definitive management in cases of combined pathology, and can be safely performed in a single surgical setting.

Keywords

AchalasiaLaryngomalaciaFailure To ThriveDysphagia
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 9 , September 2018 , pp. 852 - 855
Copyright
Copyright © JLO (1984) Limited, 2018 

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Footnotes

Dr S P Kanotra takes responsibility for the integrity of the content of the paper

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