Acquired Flaccid Larynx: A Case Report Supporting the Neurologic Theory of Laryngomalacia

Congenital flaccid larynx, also known as laryngomalacia, is a common clinical entity accounting for approximately 60% of laryngeal problems in the newborn. It is a benign and relatively asymptomatic condition that patients often outgrow by 12 to 18 months of age. A variety of mechanisms have been proposed to explain laryngomalacia including cartilage immaturity and poor neuromuscular control secondary to hypomaturity or dysfunction. This entity has only recently been described as an acquired disorder. A case of an 11-year-old boy who presented with basilar artery thrombosis and a midpontine infarction is described. Inability to extubate despite spontaneous respirations prompted flexible laryngoscopy, which revealed complete supraglottic collapse with airway obstruction. The patient was successfully treated with an epiglottoplasty. This case supports the neuromuscular dysfunction theory as a cause of laryngomalacia. (Arch Otolaryngol Head Neck Surg. 1992;118:654-657).