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Laryngopharyngeal dysfunction after the Norwood procedure
Margaret L Skinner1, Lucinda A Halstead, Catherine S Rubinstein
1Evelyn Trammell Institute of Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, Charleston, SC, USA.
The Journal of Thoracic and Cardiovascular Surgery
|November 1, 2005
Summary
Swallowing dysfunction affects nearly half of neonates after the Norwood procedure, increasing hospital stays. Recurrent laryngeal nerve injury is uncommon, and aspiration typically resolves, unlike vocal fold paralysis.
Area of Science:
- Pediatric Cardiology
- Neonatal Surgery
- Speech-Language Pathology
Background:
- The Norwood procedure is a critical first stage for hypoplastic left heart syndrome.
- Swallowing and vocal cord function are vital for neonatal outcomes post-cardiac surgery.
- Comparing functional deficits after different surgical approaches is essential for optimizing care.
Purpose of the Study:
- To compare the incidence and impact of recurrent laryngeal nerve (RLN) injury and swallowing dysfunction after the Norwood procedure versus biventricular aortic arch reconstruction.
- To assess the long-term implications of these dysfunctions on patient recovery and feeding.
Main Methods:
- Retrospective review of 36 neonates undergoing the Norwood procedure and 18 undergoing biventricular aortic arch reconstruction.
- Postoperative assessment included fiberoptic laryngoscopy and modified barium swallow (MBS) in most patients.
- Feeding regimens were guided by MBS results, including nasogastric tube use and gastrostomy tube placement.
Main Results:
- After the Norwood procedure, 48% had abnormal MBS, 24% aspirated, and 9% had vocal fold paralysis. Abnormal MBS correlated with longer hospital stays.
- After biventricular repair, 59% had abnormal MBS, 35% aspirated, and 25% had vocal fold paralysis (differences not significant).
- Aspiration resolved in 85% of patients, but vocal fold paralysis persisted in most.
Conclusions:
- Swallowing dysfunction is common after the Norwood procedure, impacting hospital stay duration.
- RLN injury is an infrequent cause of dysphagia post-Norwood; aspiration often resolves, but vocal fold paralysis is more persistent.
- Systematic swallowing evaluation aids in tailored feeding strategies, potentially reducing mortality.