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Surgery for pediatric vocal cord paralysis: a retrospective review
Christopher J Hartnick1, Matthew T Brigger, J Paul Willging
1Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, 243 Charles St, Boston, MA 02114, USA.
Insights
Vocal cord lateralization with partial arytenoidectomy offers the highest decannulation success for pediatric vocal cord paralysis. CO2 laser procedures are less effective initially but useful for revisions.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Laryngology
Background:
- Bilateral vocal cord paralysis in children often necessitates tracheotomy.
- Surgical intervention aims for decannulation and improved airway patency.
Purpose of the Study:
- To evaluate the efficacy of primary surgical procedures for decannulation in pediatric patients with bilateral vocal cord paralysis.
- To compare the operation-specific decannulation rates (OSDR) of various surgical techniques.
Main Methods:
- Retrospective review of 52 children under 18 with bilateral vocal cord paralysis and prior tracheotomy.
- Analysis of primary surgical procedures focused on decannulation outcomes.
- Comparison of OSDR, overall decannulation rates, and morbidity across different surgical methods.
Main Results:
- Vocal cord lateralization with partial arytenoidectomy achieved the highest OSDR (71%).
- This rate was significantly higher than CO2 laser cordotomy/arytenoidectomy (29%), arytenoidopexy (25%), and posterior costal cartilage grafts (60%).
- Aspiration occurred in 15% of posterior cartilage graft cases; isolated arytenoidectomy showed no primary decannulation.
Conclusions:
- Vocal cord lateralization combined with partial arytenoidectomy is the most effective primary surgical approach for pediatric bilateral vocal cord paralysis decannulation.
- CO2 laser procedures demonstrate limited primary success but are valuable for revision surgeries.
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.