Transcervical Epiglottic Suspension for Severe Type III Laryngomalacia in Infants: Feasibility, Safety, and Effectiveness

ABSTRACT Objective To evaluate the feasibility, safety, and clinical outcomes of transcervical epiglottic suspension in respiratory support‐dependent infants with Type III laryngomalacia. Methods This retrospective case series at a single‐center tertiary children's hospital included consecutive infants with endoscopically confirmed Type III laryngomalacia who were dependent on respiratory support because of upper airway obstruction. These infants underwent transcervical epiglottic suspension between January 1, 2024, and December 31, 2025. Because all eligible infants treated during the study period were included, no a priori sample size calculation was performed. Outcomes included procedural success, operative time, suture duration, perioperative complications, liberation from respiratory support, avoidance of tracheostomy, improvement in airway obstruction, feeding recovery, and catch‐up growth. Results Fifteen infants were included. Median age at surgery was 58 days. Primary procedural success was achieved in 14 of 15 infants and in all infants after revision. All infants were liberated from respiratory support, and none required tracheostomy. Airway obstruction scores improved significantly after surgery ( p < 0.001). Median operative time was 20 min, median blood loss was 1 mL, median suture duration was 35 days, and median time to full oral feeding was 35 days. Among 10 infants with preoperative growth impairment, eight achieved normal weight‐for‐age status at final follow‐up. Adverse events included premature suture detachment in two infants and minor cutaneous pressure injury in one infant; no severe complications occurred. Conclusion Transcervical epiglottic suspension was feasible and was associated with rapid liberation from respiratory support and an acceptable safety profile in high‐risk infants with Type III laryngomalacia. Level of Evidence 4