Submucosal nerve hypertrophy in congenital laryngomalacia

Objectives/Hypothesis: To determine the neuropathologic findings in tissue obtained from children with laryngomalacia at a tertiary-care pediatric hospital. Study Design: Retrospective review of consecutive cohort compared with a control group. Methods: We reviewed supra-arytenoid pathology specimens from 43 children with severe laryngomalacia and 13 age-matched pediatric autopsy controls. Histopathologic comparison was made of nerve hypertrophy (including nerve perimeter and surface area) among experimental and control pathologic specimens. Results: There exists a statistically significant increase in nerve perimeter (P =.001) and nerve surface area (P =.02) in supra-arytenoid specimens in patients with severe laryngomalacia compared with age-matched autopsy supra-arytenoid tissue. Conclusions: The pathologic finding of nerve hypertrophy in children with laryngomalacia provides new evidence to support neurologic dysfunction as the etiologic theory of laryngomalacia.