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Mathew A, Rama E, Kang K, Williams K, Birchall M, Iliadou E. Management Options for Bilateral Vocal Fold Impairment: Scoping Review to Assess the Potential of Soft Robotics Solutions. J Voice 2024:S0892-1997(24)00151-6. [PMID: 38849232 DOI: 10.1016/j.jvoice.2024.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVES This scoping review aims to comprehensively assess current surgical interventions for bilateral vocal fold paralysis (BVFP), addressing the heterogeneity in treatment outcomes. Additionally, it explores the potential role of soft robotics as an innovative approach to improve outcomes in BVFP management. METHODS This scoping review systematically examines literature from MEDLINE, Embase, and Scopus databases. Inclusion criteria encompass studies related to BVFP management with measurable subjective or objective outcomes. Studies with populations solely under the age of 18 were excluded. Four reviewers independently screened 2263 studies, resulting in the selection of 125 papers for data extraction. Information included study characteristics, interventions, and outcomes. Data synthesis involved both quantitative and qualitative analyses. RESULTS The review identified 145 surgical interventions grouped into seven types: tracheostomy, cordectomy, arytenoidectomy, lateralization, combined procedures and others. Outcome measures fit into the following categories: "objective voice," "subjective voice," "aerodynamics," "dyspnea," "decannulation," "swallow," and "quality of life." Positive outcomes were predominant across all interventions, with arytenoidectomy and cordectomy showing relatively lower rates of successful objective and subjective voice outcomes. This could be the result of prioritizing improved airway status. Soft robotics is hypothesized as a potential solution to the limitation of current interventions sacrificing voice for breathing. CONCLUSIONS The main aim of current surgical interventions for BVFP is expanding glottic aperture. Yet achieving optimal outcomes remains elusive due to complex airflow dynamics and potential impacts on phonatory function and swallowing. The current review underscores the need for a more nuanced, personalized approach, considering individual anatomical and physiological variations. Soft robotics emerges as a promising avenue to address this variability. However, challenges such as implantation procedures, long-term care, and patient education require careful consideration. Collaboration between medical professionals, engineers, and robotics specialists is essential for translating these principles into practical solutions.
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Affiliation(s)
- Alan Mathew
- University of Cambridge, Cambridge, United Kingdom.
| | - Essam Rama
- University of Cambridge, Cambridge, United Kingdom
| | - Kiran Kang
- University of Cambridge, Cambridge, United Kingdom
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Lechien JR. Management of Pediatric Bilateral Vocal Fold Paralysis: A State-of-the-Art Review of Etiologies, Diagnosis, and Treatments. CHILDREN (BASEL, SWITZERLAND) 2024; 11:398. [PMID: 38671615 PMCID: PMC11049505 DOI: 10.3390/children11040398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/18/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE This paper reviews the current literature about epidemiology, etiologies, diagnosis, and management of pediatric bilateral vocal fold paralysis (PBVFP). METHODS According to PRISMA statements, a narrative review of the current literature was conducted through the PubMed, Scopus, and Cochrane Library databases about the epidemiology, etiologies, diagnosis, and management of PBVFP. RESULTS PBVCP is the second most common congenital laryngeal anomaly in the pediatric population, accounting for 10% to 20% of pediatric laryngeal conditions. PBVCP is related to idiopathic (42.2%), congenital (19.7%), and neurological (16.9%) conditions. A tracheotomy is required in 60% of cases regarding stridor and dyspnea, which are the most prevalent symptoms. The diagnosis is based on the etiological features, clinical presentation, laryngoscopic findings, and objective examinations. Laryngeal electromyography may be used to support the diagnosis in difficult cases, but its reliability depends on the practitioner's experience. The primary differential diagnosis is posterior glottis stenosis, which needs to be excluded regarding therapeutic and management differences with PBVCP. Transient surgical procedures consist of tracheotomy or laterofixation of the vocal fold. Current permanent procedures include uni- or bilateral partial arytenoidectomy, posterior transverse cordotomy, cricoid splits, and laryngeal selective reinnervation. There is no evidence of the superiority of some procedures over others. CONCLUSIONS PBVCP is the second most common laryngeal disorder in the pediatric population. Diagnosis is based on etiological and clinical findings and may require the use of laryngeal electromyography. Therapeutic management may involve several transient or permanent surgical procedures that are associated with overall subjective improvements in symptoms, laryngeal findings, and low complication rates.
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Affiliation(s)
- Jerome R. Lechien
- Research Committee of the Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, 92150 Paris, France;
- Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, B1000 Brussels, Belgium
- Department of Otolaryngology, Elsan Hospital, 92150 Paris, France
- Department of Otolaryngology-Head and Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), 92150 Paris, France
- Division of Laryngology and Bronchoesophagology, Department of Otolaryngology Head Neck Surgery, Faculty of Medicine, EpiCURA Hospital, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), B7000 Mons, Belgium
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Trozzi M, Torsello M, Meucci D, Micardi M, Tropiano ML, Balduzzi S, Ossandon Avetikian A, Salvati A, Bottero S. Pediatric Bilateral Vocal Cord Immobility: New Treatment With Preservation of Voice. Laryngoscope 2023; 133:2325-2332. [PMID: 36579686 DOI: 10.1002/lary.30535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/25/2022] [Accepted: 12/08/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Pediatric bilateral vocal cord immobility (BVCI) represents a severe life-threatening condition that often causes severe dyspnea. Endoscopic arytenoid lateral abduction (EALA) is a relatively new, secure, minimal-invasive surgical technique. The present prospective observational study aims to evaluate the effects of EALA in terms of respiratory function, voice quality, and swallowing capabilities. METHODS Twenty-one pediatric patients with BVCI underwent EALA. Eleven out of 21 patients had tracheostomy at the time of surgery. Pre and postoperative functional assessments included endoscopic evaluation, maximum phonation time, pediatric Voice Handicap Index (pVHI), GIRBAS Scale criteria, and Montreal Children's Hospital Feeding scale (MCH-Feeding scale). peak tidal inspiratory flow or peak inspiratory flow (PIF) and number of desaturations/hour (ODI/h) were evaluated in patients without tracheostomy. RESULTS Postoperative endoscopy showed glottic airway improvement in all patients. Average time for decannulation was 4.6 weeks. One patient has not yet been decannulated. No major complications occurred. In patients without tracheostomy, we observed a significant improvement of ODI/h and PIF after surgery (p < 0.05) as expected. PVHI, MCH-Feeding scale, and GIRBAS score significantly worsened 1 month after surgical intervention (p < 0.05). One year after surgery, however, all values, except for B and A parameters of the GIRBAS score, returned to levels comparable to those preoperative. CONCLUSIONS EALA represents a simple, safe and effective solution in pediatric patients with BVCI, avoiding tracheostomy, allowing early decannulation, preserving swallowing function, and maintaining good quality voice. LEVEL OF EVIDENCE 4 Laryngoscope, 133:2325-2332, 2023.
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Affiliation(s)
- Marilena Trozzi
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Miriam Torsello
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Duino Meucci
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mariella Micardi
- Audiology and Otosurgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria L Tropiano
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sara Balduzzi
- Department of Diagnostic, Clinical and Public Health Medicine, Modena and Reggio Emilia University Hospital, Modena, Italy
| | | | - Antonio Salvati
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sergio Bottero
- Airway Surgery Unit, Department of Surgical Specialties, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Pereira NM, Modi VK. Endoscopic Anterior and Posterior Cricoid Split for Bilateral Vocal Fold Paralysis. Laryngoscope 2021; 132:459-460. [PMID: 34581442 DOI: 10.1002/lary.29752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/15/2021] [Accepted: 07/05/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Nicola M Pereira
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A
| | - Vikash K Modi
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology-Head and Neck Surgery, Weill Cornell Medical College, New York, New York, U.S.A
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Trozzi M, Meucci D, Salvati A. Endoscopic Arytenoid LateroAbduction (EALA) in the treatment of bilateral vocal cord paralysis. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138 Suppl 1:12-13. [PMID: 34053888 DOI: 10.1016/j.anorl.2021.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/03/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Affiliation(s)
- M Trozzi
- Airway Surgery Unit, Derpartment of Surgical Specialties, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - D Meucci
- Airway Surgery Unit, Derpartment of Surgical Specialties, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
| | - A Salvati
- Airway Surgery Unit, Derpartment of Surgical Specialties, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165 Rome, Italy
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Lee JW, Bon-Mardion N, Smith ME, Marie JP. Bilateral Selective Laryngeal Reinnervation for Bilateral Vocal Fold Paralysis in Children. JAMA Otolaryngol Head Neck Surg 2021; 146:401-407. [PMID: 32191278 DOI: 10.1001/jamaoto.2019.4863] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Bilateral vocal fold paralysis (BVFP) in pediatric patients is a challenging entity with multiple causes. Traditional approaches to managing BVFP include tracheostomy, arytenoidectomy, suture lateralization, cordotomy, and posterior cricoid enlargement. These interventions are used to create a stable airway but risk compromising voice quality. Objectives To assess the use of bilateral selective laryngeal reinnervation (SLR) surgery to manage BVFP and restore dynamic function to the larynx in pediatric patients. Design, Setting, and Participants In this case series performed at 2 tertiary care academic institutions, 8 pediatric patients underwent bilateral SLR to treat BVFP (5 patients with iatrogenic BVFP and 3 with congenital BVFP) from November 2004 to August 2018 with follow-up for at least 1.5 years. Interventions Bilateral selective laryngeal reinnervation surgery. Main Outcomes and Measures Flexible laryngoscopy findings, subjective and objective measures of voice quality, subjective swallowing function, and decannulation in patients who were previously dependent on a tracheostomy tube. Results Participants included 6 boys and 2 girls with a median age of 9.3 (range, 2.2 to 18.0) years at the time of surgery. All 8 patients were decannulated; 6 patients had preoperative tracheostomies and 2 had perioperative tracheostomies. Voice quality, as measured using the GRBAS (grade, roughness, breathiness, asthenia, strain) scale, improved in 6 of 8 patients after reinnervation, and swallowing was not impaired in any patients. In 2 patients, GRBAS scale scores remained the same before and after surgery. Inspiratory vocal fold abduction was observed on both sides in 5 patients and on 1 side in 2 patients, with no active abduction observed in 1 patient. The follow-up period was more than 5 years in 7 of 8 patients and at least 1.5 years in all patients. Conclusions and Relevance Bilateral SLR appears to be a promising treatment option for children with BVFP; it is currently the only option, to our knowledge, with the potential to restore abductor and adductor vocal fold movement. In patients with complete paralysis, this procedure may provide a strategy for airway management and restoration of the dynamic function of the larynx. It could be considered as a first-line technique before endolaryngeal or airway framework procedures, which carry a risk of compromising voice quality.
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Affiliation(s)
- Janet W Lee
- Division of Otolaryngology-Head & Neck Surgery, University of Utah School of Medicine, Salt Lake City.,Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Nicolas Bon-Mardion
- Research Group on Ventilatory Handicap (EA 3830 GRHV), The Rouen Institute for Research and Innovation in Biomedicine, Rouen, Normandy, France.,Department of Otorhinolaryngology-Head and Neck Surgery and Audiophonology, University Hospital, Rouen, France
| | - Marshall E Smith
- Division of Otolaryngology-Head & Neck Surgery, University of Utah School of Medicine, Salt Lake City
| | - Jean-Paul Marie
- Research Group on Ventilatory Handicap (EA 3830 GRHV), The Rouen Institute for Research and Innovation in Biomedicine, Rouen, Normandy, France.,Department of Otorhinolaryngology-Head and Neck Surgery and Audiophonology, University Hospital, Rouen, France
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Experience with laryngeal reinnervation using nerve-muscle pedicle in pediatric patients. Int J Pediatr Otorhinolaryngol 2020; 138:110254. [PMID: 33137867 DOI: 10.1016/j.ijporl.2020.110254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/04/2020] [Accepted: 07/05/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Vocal fold paralysis (VFP) in adducted position remains a challenge for airway surgeons. Alternatives to tracheostomies such as lateralization, cordectomy, and posterior rib grafting disrupt the laryngeal tissue or framework and carry an increased risk of aspiration. Laryngeal reinnervation using nerve-muscle pedicle (NMP), carries the distinct advantage of preserving the larynx, sparing the recurrent laryngeal nerve, and obtaining an active VF abduction. The aim of this study was to evaluate the success and complications of laryngeal reinnervation using nerve-muscle pedicle (NMP) in pediatric patients presenting with dyspnea related to VFP in adducted position. METHODS In this case series performed at a tertiary care referral center, review of medical records on all pediatric patients with VFP in adduction treated with laryngeal reinnervation using NMP between 1999 and 2017. Data were collected on the preoperative flexible laryngoscopy, suspension micro-laryngoscopy, and laryngeal electromyography as well as post-operative clinical assessment of the voice and airway. All patients underwent surgery consisting of the transfer of an innervated omohyoid muscle pedicle onto the paralyzed posterior cricoarytenoid muscle. The main outcomes measured were the clinical and fiberoptic laryngoscopic airway assessment monthly for the first 6 months, then at 12 months and annually thereafter. Clinical assessment included dyspnea evaluation based on a visual analog scale and voice assessment using the GRBAS scores. Complications from the treatment were also noted. These outcomes were determined before collection of data. RESULTS 16 cases were identified, with a mean age of 4 years. The recurrent laryngeal nerve paralysis was bilateral in 3 cases and unilateral in 13 cases. There were no peri or postoperative complications. After a mean follow-up of 7 years, vocal fold abduction was observed in 10 out of 16 cases and disappearance of paradoxical inspiratory adduction in 3 cases. Persistent dyspnea was noted in 7 cases (44%), and moderate dysphonia was present in 11 cases (69%). Finally, additional procedures were necessary in 2 patients (13%) to achieve the outcomes. CONCLUSIONS Laryngeal reinnervation using NMP may be used in pediatric patients. This procedure, is safe and allows us to spare the recurrent laryngeal nerve while obtaining an active VF abduction in the majority of cases, and an improvement in breathing in most cases. QUALITY OF EVIDENCE 4.
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8
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Thorpe RK, Kanotra SP. Surgical Management of Bilateral Vocal Fold Paralysis in Children: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2020; 164:255-263. [PMID: 32689890 PMCID: PMC10042623 DOI: 10.1177/0194599820944892] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To examine and compare the outcomes of various types of glottic widening surgery (GWS) for initial management of bilateral vocal fold paralysis (BVFP) in children, the outcomes of different GWS procedures in children who underwent initial tracheostomy, and the rate of decannulation in children who underwent tracheostomy alone versus tracheostomy followed by GWS. DATA SOURCES PubMed, Web of Science, Cochrane Library, and Embase were searched following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) on September 9, 2019, with no date restriction. REVIEW METHODS Articles focusing on GWS or tracheostomy for initial management of BVFP were included. Articles describing patients who received no surgical intervention for BVFP were excluded. RESULTS A total of 5989 articles were reviewed: 67 articles met inclusion criteria, and 240 patients were incorporated into the analysis. Patients who underwent primary GWS had an eventual tracheostomy rate of 6.0% (5/83). There were no statistically significant differences in the rate of tracheostomy, reoperation, or mortality among cricoid split, suture lateralization, and cordectomy/cordotomy. Patients who underwent primary tracheostomy failed to achieve decannulation in 36.9% (58/157) of cases. Decannulation was more likely in tracheostomized children who received GWS than those who did not (odds ratio, 6.336; P < .0001). CONCLUSIONS Most children who undergo primary GWS for BVFP avoid tracheostomy or reoperation. These data demonstrated no differences in surgical outcomes among the most common types of GWS for BVFP. For children who receive a tracheostomy as their first intervention for BVFP, GWS is associated with a significantly improved rate of decannulation.
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Affiliation(s)
- Ryan Kendall Thorpe
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Sohit Paul Kanotra
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA.,University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
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Abstract
Congenital or acquired disorders of the pediatric airway can affect the upper, lower, or entire airway. There are fundamental differences between the anatomy and physiology of the neonate, pediatric, and adult airways. Infants are not merely small adults in this respect and size, surface area, proportion, resistance, and compliance vary greatly between the age groups. A clear understanding of these significant differences and how they affect patients dependent on age is key to appropriate management.
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Affiliation(s)
- Shyan Vijayasekaran
- Faculty of Medicine and health sciences, University of Western Australia, Perth, WA, Australia.,Department of Otolaryngology Head and Neck Surgery, Perth Children's hospital, Nedlands, WA, Australia
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Trozzi M, Meucci D, Salvati A, Tropiano ML, Bottero S. Surgical Options for Pediatric Bilateral Vocal Cord Palsy: State of the Art. Front Pediatr 2020; 8:538562. [PMID: 33363058 PMCID: PMC7755890 DOI: 10.3389/fped.2020.538562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/09/2020] [Indexed: 01/17/2023] Open
Abstract
Management of pediatric bilateral vocal cord palsy (BVCP) is a controversial and challenging topic. It may represent a severe obstructive condition usually associated with respiratory distress, and, in such condition, tracheostomy has been considered the gold standard for a long time. Many surgical options have been described and used to increase the glottic space in BVCP (1), with ongoing research of less invasive techniques. The challenge and current trend in our department and in many major pediatric centers is to avoid tracheotomy through an early treatment. Many techniques introduced in the last decade reduced the number of tracheotomies and increased the decannulation rate. Furthermore, we observed a recent increase in attention to preserve the quality of the voice with new techniques, such as endoscopic arytenoid abduction lateropexy which is in our opinion an important innovation to improve glottic space with satisfactory voice results. We present a review of the literature about the evolution of the treatment options for pediatric BVCP during the years.
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Affiliation(s)
- Marilena Trozzi
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Duino Meucci
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonio Salvati
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Maria Luisa Tropiano
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Sergio Bottero
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children's Hospital, Rome, Italy
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Abstract
Stridor, a common presenting sign of respiratory distress in a newborn, has many systemic causes. It may arise from the larynx or the tracheobronchial airway. This article presents the most common pathologic conditions in this anatomic region, with highlights on management.
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Affiliation(s)
- Jay Bhatt
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, 13123 E 16th Avenue, B-455, Aurora, CO 80045, USA
| | - Jeremy D Prager
- Department of Otolaryngology, University of Colorado School of Medicine, 12631 E. 17th Avenue, B-205, Aurora, CO 80045, USA.
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Montague GL, Bly RA, Nadaraja GS, Conrad DE, Parikh SR, Chan DK. Endoscopic percutaneous suture lateralization for neonatal bilateral vocal fold immobility. Int J Pediatr Otorhinolaryngol 2018; 108:120-124. [PMID: 29605340 DOI: 10.1016/j.ijporl.2018.02.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 02/09/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Bilateral vocal-fold immobility (BFVI) is a rare but significant cause of severe respiratory distress in neonates. The primary aim of treatment is to provide an adequate airway while minimizing adverse effects such as aspiration and dysphonia. Our objective here is to describe the outcomes of a series of neonates undergoing percutaneous endoscopic suture lateralization for BVFI using a novel technique. METHODS In this retrospective case series, we present 6 neonates (mean age: 18 days) with BVFI from three tertiary academic medical centers. The etiologies included 4 idiopathic, 1 unspecified neurodegenerative disorder, and 1 acquired from cardiac surgery. All had stridor and respiratory distress with hypoxemia requiring respiratory support at diagnosis. Endoscopic vocal-fold lateralization was performed under spontaneous-breathing suspension laryngoscopy using a novel technique of percutaneous needle-directed placement of 4-0 prolene suture without use of specialized equipment. RESULTS All patients had clinical improvement in stridor and respiratory support requirements and avoided tracheostomy. One patient had persistent aspiration after lateralization that resolved after suture removal. One patient required bilateral lateralization procedures. One patient expired of epilepsy due to neurodegenerative disease unrelated to airway pathology. At last follow-up (mean 12.6 months), 5/5 remaining patients were on room air without tracheostomy and feeding orally without aspiration; 4/5 had partial or complete return of vocal-fold function. CONCLUSION Endoscopic percutaneous suture lateralization may be a safe and effective non-destructive primary treatment modality for neonatal BVFI. All neonates undergoing this procedure avoided tracheotomy.
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Affiliation(s)
- Glenda Lois Montague
- UCSF-Benioff Children's Hospital, Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, United States
| | - Randall A Bly
- Seattle Children's Hospital, Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of Washington, United States
| | - Garani S Nadaraja
- UCSF-Benioff Children's Hospital, Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, United States
| | - David E Conrad
- UCSF-Benioff Children's Hospital, Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, United States
| | - Sanjay R Parikh
- Seattle Children's Hospital, Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of Washington, United States
| | - Dylan K Chan
- UCSF-Benioff Children's Hospital, Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, United States.
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Navazo Eguía AISABEL, ANTÓN-PACHECO SÁNCHEZ JUANLUIS. Obstrucción crónica de la vía aérea en la infancia. Causas más frecuentes. Tratamiento quirúrgico y endoscópico. REVISTA ORL 2017. [DOI: 10.14201/orl.15901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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14
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Madani S, Bach Á, Matievics V, Erdélyi E, Sztanó B, Szegesdi I, Castellanos PF, Rovó L. A new solution for neonatal bilateral vocal cord paralysis: Endoscopic arytenoid abduction lateropexy. Laryngoscope 2016; 127:1608-1614. [DOI: 10.1002/lary.26366] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Shahram Madani
- Department of Otorhinolaryngology and Head and Neck Surgery, Stepping Hill Hospital; Stockport National Health Service Foundation Trust; Stockport United Kingdom
| | - Ádám Bach
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine; University of Szeged; Szeged Hungary
| | - Vera Matievics
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine; University of Szeged; Szeged Hungary
| | - Eszter Erdélyi
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine; University of Szeged; Szeged Hungary
| | - Balázs Sztanó
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine; University of Szeged; Szeged Hungary
| | - Ilona Szegesdi
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine; University of Szeged; Szeged Hungary
| | - Paul F. Castellanos
- Department of Otolaryngology-Head and Neck Surgery; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - László Rovó
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine; University of Szeged; Szeged Hungary
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Jomah M, Jeffery C, Campbell S, Krajacic A, El-Hakim H. Spontaneous recovery of bilateral congenital idiopathic laryngeal paralysis: systematic non-meta-analytical review. Int J Pediatr Otorhinolaryngol 2015; 79:202-9. [PMID: 25555638 DOI: 10.1016/j.ijporl.2014.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 12/07/2014] [Accepted: 12/08/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To systematically review the frequency and time to spontaneous recovery in pediatric patients with bilateral congenital idiopathic laryngeal paralysis (BCILP). METHODS The databases of Medline, EMBASE, Scopus, CINAHL, Cochrane Library and Proquest Dissertations were searched for English language articles reporting on laryngeal paralysis in pediatric patients. A bibliography search of the selected studies was done to identify additional articles. We included prospective or retrospective case-series studies of children and neonates diagnosed with BCILP at age <60 days and confirmed by direct laryngoscopy, with sufficient follow up and objective assessment for recovery. Two authors independently extracted the data and assessed the quality of each study. Discrepancies were resolved by consensus and adjudication by a third author. RESULTS Of the 4229 articles identified by the search, only one study met our inclusion criteria. The study was a retrospective case series, and was of low quality. The mean age at diagnosis was fourteen days. Sixty-five percent of the patients recovered spontaneously, and the mean time to recovery was twenty-five months. Tracheostomy was performed in 71% of the patients. CONCLUSIONS The available literature is of low quality and provides weak evidence on the natural history of BCILP in pediatric population.
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Affiliation(s)
- Mohammed Jomah
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Caroline Jeffery
- Division of Otolaryngology - Head & Neck Surgery, The Stollery Children's Hospital & The University of Alberta Hospitals, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra Campbell
- John W. Scott Health Science Library, University of Alberta, Edmonton, Alberta, Canada
| | - Aleksandra Krajacic
- Department of Surgery, The Stollery Children's Hospital & The University of Alberta Hospitals, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Hamdy El-Hakim
- Pediatric Otolaryngology Service, Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, The Stollery Children's Hospital & The University of Alberta Hospitals, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Pediatric Otolaryngology Service, Division of Pediatric Surgery, Department of Pediatrics, The Stollery Children's Hospital & The University of Alberta Hospitals, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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Paediatric Vocal Fold Paralysis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013. [DOI: 10.1016/j.otoeng.2013.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Garcia-Lopez I, Peñorrocha-Teres J, Perez-Ortin M, Cerpa M, Rabanal I, Gavilan J. Paediatric vocal fold paralysis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013; 64:283-8. [PMID: 23726279 DOI: 10.1016/j.otorri.2013.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 01/28/2013] [Accepted: 02/03/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Vocal fold paralysis (VFP) is a relatively common cause of stridor and dysphonia in the paediatric population. This report summarises our experience with VFP in the paediatric age group. METHODS All patients presenting with vocal fold paralysis over a 12-month period were included. Medical charts were revised retrospectively. The diagnosis was performed by flexible endoscopic examination. The cases were evaluated with respect to aetiology of the paralysis, presenting symptoms, delay in diagnosis, affected side, vocal fold position, need for surgical treatment and outcome. RESULTS The presenting symptoms were stridor and dysphonia. Iatrogenic causes formed the largest group, followed by idiopathic, neurological and obstetric VFP. Unilateral paralysis was found in most cases. The median value for delay in diagnosis was 1 month and it was significantly higher in the iatrogenic group. Surgical treatment was not necessary in most part of cases. CONCLUSIONS The diagnosis of VFP may be suspected based on the patient's symptoms and confirmed by flexible endoscopy. Infants who develop stridor or dysphonia following a surgical procedure have to be examined without delay. The surgeon has to keep in mind that there is a possibility of late spontaneous recovery or compensation.
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Affiliation(s)
- Isabel Garcia-Lopez
- Servicio de Otorrinolaringología, Hospital Universitario La Paz, Madrid, España.
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Nisa L, Holtz F, Sandu K. Paralyzed neonatal larynx in adduction. Case series, systematic review and analysis. Int J Pediatr Otorhinolaryngol 2013; 77:13-8. [PMID: 23164501 DOI: 10.1016/j.ijporl.2012.10.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 10/22/2012] [Accepted: 10/24/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Bilateral vocal cord abductor paralysis (BVCAbP) is considered a rare cause of stridor in the newborn. The goal of this work is to present a case series and to review systematically the literature on bilateral vocal cord abductor paralysis in the newborn to better characterize the current knowledge on this entity. METHODS We performed a systematic literature review with Medline (1950-2011). The authors screened all cases of BVCAbP reported and selected those affecting newborns. RESULTS Out of the 129 articles screened, 16 were included. A total of 69 cases could be retrieved and analyzed. Associated co-morbidities were found in 54% of the patients, most notably malformative conditions (intracranial or other), or a positive perinatal history (trauma/asphyxia, prematurity). Tracheostomy placement was required in 59% of children, and of these 44% were successfully decannulated. In terms of functional outcome full recovery or improvement were seen in 61% of patients. Major underlying co-morbidities affected negatively the functional outcome (p=.004), but not the need for tracheostomy (p=.604) or the decannulation success rate (p=.063). CONCLUSION BVCAbP in the newborn is a serious cause of airway obstruction. It can be seen either in a context of multisystem anomalies or as an isolated finding. Newborns with major co-morbidities affecting their normal development are more likely to have poor functional outcomes and to remain tracheostomy-dependant.
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Affiliation(s)
- L Nisa
- Department of Otorhinolaryngology - Head and Neck Surgery, Hôpital de Sion - CHCVs/RSV, Avenue du Grand Champsec 80, 1950 Sion, Switzerland.
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Prisman E, Chadha NK, Gordon A, Estrada M, Campisi P, Forte V. A novel endoscopically placed stent to relieve glottic obstruction from bilateral vocal fold paralysis. Int J Pediatr Otorhinolaryngol 2011; 75:182-5. [PMID: 21081249 DOI: 10.1016/j.ijporl.2010.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 10/20/2010] [Accepted: 10/24/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Congenital bilateral vocal fold paralysis (BVP) is a rare but serious condition often requiring a tracheostomy to temporize the airway. In cases of idiopathic BVP, studies suggest waiting twelve months prior to laryngeal surgery because of a high rate of spontaneous recovery. Therefore a less invasive and reversible intervention would be optimal. A prospective study in a piglet model was undertaken to evaluate the efficacy of a novel spring-loaded stenting device designed to maintain laryngeal patency in an in vivo animal model of BVP. METHODS Eight Yorkshire piglets had BVP induced by surgical division of the recurrent laryngeal nerves. Stents were endoscopically deployed between the arytenoid vocal processes. Animals were recovered and monitored for stridor, dietary intake, and weight gain. Animals were sacrificed after five days. Airway resistance using a calibrated manometer was measured at four time-points: baseline, BVP induction, stent insertion, and pre-sacrifice. RESULTS Six of eight animals survived greater than five days with an average weight gain of 1.9kg (p=0.003). Relative inspiratory resistance increased from baseline after inducing BVP (1.00 vs. 1.468, p=0.0315) and decreased to baseline levels with stent insertion (1.468 vs. 1.092, p=0.0238). Expiratory resistance was not significantly influenced by stage of measurement (p=0.236). Of the two animals not surviving the protocol, one had an unrelated anesthesia complication and the other a malpositioned stent. CONCLUSION The novel stent was successful in relieving the inspiratory resistance associated with BVP, without compromising swallowing and daily function. This may hold promise in temporarily securing the pediatric airway in the setting of BVP.
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Affiliation(s)
- Eitan Prisman
- Department of Otolaryngology-Head and Neck Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
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Lagier A, Nicollas R, Sanjuan M, Benoit L, Triglia JM. Laser cordotomy for the treatment of bilateral vocal cord paralysis in infants. Int J Pediatr Otorhinolaryngol 2009; 73:9-13. [PMID: 19019461 DOI: 10.1016/j.ijporl.2008.09.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 09/01/2008] [Accepted: 09/04/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Vocal cord paralysis is the second cause of neonatal stridor. Several surgical treatments are proposed in order to avoid tracheotomy or to decanulate patients. Laser posterior partial cordotomy is supposed to be a minimal invasive procedure. The purpose of the study is to share our experience in management of laryngeal paralysis with this technique in infants and appreciate its role in avoiding tracheotomy in infants. DESIGN Retrospective study. PATIENTS The charts of 0-2-year-old patients treated for vocal cord paralysis from 1996 to 2007 are reviewed. Eleven infants with bilateral laryngeal paralysis in adduction presented severe dyspnoea. Tracheotomy was performed in four out of them, proposed in five others. One infant out of 11 underwent long-term intubation, and one presented with progressive dyspnoea. RESULTS The laser posterior partial cordotomy allowed the decanulation after one session (n=2) or avoided tracheotomy (n=5), one patient had significant improvement of his respiratory function. Two patients needed a second session of laser cordotomy and were decanulated. The functional results for the voice and swallowing qualities were subjectively satisfactory. One patient had pejorative evolution. CONCLUSION Posterior partial cordotomy is an effective, minimal invasive technique which can be proposed to avoid tracheotomy in infants with bilateral adduction vocal cord paralysis. No functional sequelae were observed.
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Affiliation(s)
- Aude Lagier
- Department of Pediatric Otorhinolaryngology, La Timone Children's Hospital, 13385 Marseille cedex 5, France
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Chen EY, Inglis AF. Bilateral Vocal Cord Paralysis in Children. Otolaryngol Clin North Am 2008; 41:889-901, viii. [DOI: 10.1016/j.otc.2008.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rudmik LR, Walen SG, Dixon E, Dort J. Evaluation of meta-analyses in the otolaryngological literature. Otolaryngol Head Neck Surg 2008; 139:187-94. [DOI: 10.1016/j.otohns.2008.03.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 03/11/2008] [Accepted: 03/19/2008] [Indexed: 11/26/2022]
Abstract
OBJECTIVE: To evaluate the quality of meta-analyses written on otolaryngological topics and define areas that can be improved upon in future studies. DATA SOURCES: MEDLINE (PubMed) and EMBASE databases were searched. The Cochrane database of systematic reviews was excluded, because these meta-analyses have already been critically evaluated and found to be of high quality. REVIEW METHODS: A systematic review of otolaryngological meta-analyses published between 1997 and 2006 (10 years) was performed in duplicate and independently by two authors. The search included 16 common otolaryngological terms. Inclusion criteria were meta-analytic methodology, otolaryngological topic, and at least one author from a department of otolaryngology. Fifty-one articles fulfilled eligibility criteria. In duplicate and independently, two reviewers assessed the quality of eligible metaanalyses using a validated 10-item index called the Overview Quality Assessment Questionnaire. Using the methods of Spearman, correlation coefficients are reported for associations examined between covariates and the Overall Score Quality. RESULTS: The majority of studies had methodologic flaws (mean score 3.9, scale of 1-7). Variables predicting higher-quality meta-analyses were publication in journals with higher impact factors ( P = 0.0007) and authors who previously published metaanalyses ( P = 0.0001). Using and reporting about a validity assessment tool needs to be improved upon in future studies. CONCLUSION: The quality of meta-analyses on otolaryngological topics is moderate. Future meta-analyses can be improved upon by following evidence-based guidelines for the reporting of metaanalyses, which include the use of a validity assessment tool, and consulting with an author familiar with meta-analysis methodology.
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Affiliation(s)
- Luke R. Rudmik
- Departments of Otolaryngology, Calgary, Alberta, Canada (Drs Rudmik, Walen, and Dort)
| | - Scott G. Walen
- Departments of Otolaryngology, Calgary, Alberta, Canada (Drs Rudmik, Walen, and Dort)
| | - Elijah Dixon
- Departments of General Surgery (Dr Dixon), University of Calgary
| | - Joseph Dort
- Departments of Otolaryngology, Calgary, Alberta, Canada (Drs Rudmik, Walen, and Dort)
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El-Hakim H. Injection of Botulinum Toxin into External Laryngeal Muscles in Pediatric Laryngeal Paralysis. Ann Otol Rhinol Laryngol 2008; 117:614-20. [DOI: 10.1177/000348940811700812] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: I undertook to demonstrate the effect of injecting botulinum toxin type A (BTA) into cricothyroid, sternothyroid, and sternohyoid muscles in cases of bilateral laryngeal paralysis (BLP). Tracheostomy remains the consistently reproducible and accepted method to salvage the airway obstruction in BLP. The bypass, however, acknowledges the current lack of knowledge and consensus on the pathogenesis. Methods: I performed a retrospective chart review of BLP cases treated with BTA in a tertiary care pediatric center. The injections were performed under direct vision through an open transcervical approach. The main outcome measures used were improvement of airway symptoms and endoscopic findings, tracheostomy requirement, and incidence of recovery of function. Results: In total, 24 patients with BLP were identified. Over a 2-year period, 7 patients were treated with BTA. Six patients had congenital idiopathic BLP. One of these had trisomy 7. One patient acquired the paralysis after cardiac surgery. No patients required a tracheostomy, except for the infant with trisomy 7. Six patients recovered function completely, and the seventh recovered it partially (range, 4 weeks to 12 months). Conclusions: Injection of BTA into external laryngeal muscles may be an alternative to tracheostomy in BLP. It is proposed that the toxin relaxes the glottic aperture by paralyzing the cricothyroid and strap muscles and that it may aid in appropriate reinnervation of the larynx via mechanisms beyond the neuromuscular junction.
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Schultz P, Charpiot A, Edrissi M, Fauvet F, Donato L, Debry C. [Bilateral vocal cords paralysis in newborn]. ANNALES D'OTO-LARYNGOLOGIE ET DE CHIRURGIE CERVICO FACIALE : BULLETIN DE LA SOCIETE D'OTO-LARYNGOLOGIE DES HOPITAUX DE PARIS 2007; 124:103-9. [PMID: 17521600 DOI: 10.1016/j.aorl.2006.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Accepted: 10/26/2006] [Indexed: 05/15/2023]
Abstract
OBJECTIVE This study aims at analyzing medical and surgical management as well as long-term follow-up of newborn (n=8) suffering from bilateral vocal cord paralysis. METHODS This retrospective study reports information regarding pregnancy and birth history, family history, initial and delayed clinical features, treatment and follow-up of these infants. The following laryngeal procedures have been performed: Laser cordectomy (n=3), arytenoidopexy by external approach (n=2), botulinum toxin injection alone or associated with surgical treatments (n=6), enlargement laryngoplasty (n=1), endolaryngeal prostheses insertion (n=2). RESULTS Any spontaneous recovery has been noticed. Four patients experiencing swallowing disorders required a gastrostomy in proportion to neurologic diseases and association of anomalies. Electromyograms performed were unremarkable. Botulinum toxin injected alone in laryngeal adductor muscles was not effective. The best results were observed when both arytenoidopexy and botulinum toxin injection were carried out. Bilateral cordectomies have been disappointing because of persistent vocal cord adduction. CONCLUSION The low probability of spontaneous recovery and the drawbacks of tracheotomy encourage us to perform vocal cords adduction procedures as soon as possible.
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Affiliation(s)
- P Schultz
- Service d'ORL et de chirurgie cervicofaciale, CHU de Hautepierre, avenue Molière, 67098 Strasbourg cedex, France
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Butnaru CS, Colreavy MP, Ayari S, Froehlich P. Tracheotomy in children: evolution in indications. Int J Pediatr Otorhinolaryngol 2006; 70:115-9. [PMID: 16169607 DOI: 10.1016/j.ijporl.2005.05.028] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2004] [Revised: 05/17/2005] [Accepted: 05/22/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To evaluate the evolution of indications for tracheostomy in children. METHODS A retrospective review of 46 children undergoing tracheostomy between 1996 and 2001. RESULTS The indications for tracheostomy were classified in two groups:(1) prolonged ventilator dependence (57%), (2) upper airway obstructions (43%). The average age of the tracheostomy was 3 years and 8 months. This was higher in the first group (5.5 years). Decannulation was accomplished in 52%. The indications for tracheostomy were evaluated and were found to decrease in frequency for upper airway obstructions. An increasing indication was for chronic disorders requiring prolonged ventilator dependence. Complications occurred in 50% of children. Overall mortality was 13-2.7% directly related to the tracheostomy. CONCLUSIONS Evolving indication has been ventilator dependence. Upper airway obstruction as an indication has diminished in frequency, especially with the concomitant progress of endoscopic techniques.
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Affiliation(s)
- C S Butnaru
- Otolaryngology Department, Edouard Herriot Universitary Hospital, Place d'Arsonval, 69437 Lyon Cedex 03, France
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Patel NJ, Kerschner JE, Merati AL. The use of injectable collagen in the management of pediatric vocal unilateral fold paralysis. Int J Pediatr Otorhinolaryngol 2003; 67:1355-60. [PMID: 14643481 DOI: 10.1016/j.ijporl.2003.08.045] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Vocal fold paralysis (VFP) is the second most common congenital abnormality that affects the larynx. Unilateral cases may be asymptomatic or feature symptoms related to laryngeal incompetence, such as aspiration and dysphonia. Management has traditionally been conservative as a high percentage of these paralyses recover spontaneously. The literature is scant on the acute or chronic management of unilateral vocal fold paralysis related symptoms in children. We present a series of four children (age 21 days, 5 years, 5 years, and 18 years) with unilateral VFP paralysis treated with collagen (Cymmtera) augmentation for control of symptoms related to laryngeal incompetence. Two children (age 21 days and 5 years) were managed in the acute setting. Follow-up has ranged from 4 to 12 months, and all have maintained excellent outcomes. Vocal fold augmentation with collagen is an effective therapeutic option in the management of symptoms related to unilateral VFP and laryngeal incompetence. It decreases the risk of aspiration and improves vocal quality. Collagen augmentation can be used in the acute setting to decrease aspiration, possibly avoiding a tracheotomy or gastrostomy tube placement, or to augment patients with a tracheotomy who are still severely aspirating.
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Affiliation(s)
- Nalin J Patel
- Department of Otolaryngology and Communication Sciences, Division of Pediatric Otolaryngology, Medical College of Wisconsin, Milwaukebe, WI 53045, USA.
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Hartnick CJ, Brigger MT, Willging JP, Cotton RT, Myer CM. Surgery for pediatric vocal cord paralysis: a retrospective review. Ann Otol Rhinol Laryngol 2003; 112:1-6. [PMID: 12537049 DOI: 10.1177/000348940311200101] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To determine the outcome of surgical procedures for bilateral vocal cord paralysis in children, we performed a retrospective review of children under 18 years of age with bilateral vocal cord paralysis and a previous tracheotomy who underwent a primary procedure at a single tertiary care institution with an aim of decannulation. The primary outcome measure was the operation-specific decannulation rate (OSDR). The overall decannulation rates, as well as morbidity rates, were also recorded. Fifty-two children met the inclusion criteria (mean age at time of primary surgery, 6.2 years; SD, 5 years). Vocal cord lateralization procedures combined with a partial arytenoidectomy achieved the highest OSDR (17/24 or 71%). This OSDR was statistically higher than the OSDRs for CO2 laser cordotomy or arytenoidectomy procedures (OSDR, 5/17 or 29%, p = .008), for isolated arytenoidopexy procedures (OSDR, 1/4 or 25%, p = .000004), or for posterior costal cartilage graft procedures (OSDR, 3/5 or 60%, p = .0004). Neither of the 2 children who underwent isolated arytenoidectomy achieved primary decannulation. The incidence of aspiration following posterior cartilage graft procedures was 15% (2/15). Subanalysis by age failed to reveal differences in OSDR. We conclude that vocal cord lateralization procedures with partial arytenoidectomy afford the highest OSDR among primary procedures for pediatric vocal cord paralysis. The CO2 laser procedures, while having limited success as a primary procedure, are effective for revision.
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Affiliation(s)
- Christopher J Hartnick
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114, USA
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