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Surgical Interventions for Pediatric Unilateral Vocal Cord Paralysis: A Systematic Review
Oleksandr Butskiy1, Bhavik Mistry2, Neil K Chadha1
1Division of Pediatric Otolaryngology-Head and Neck Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada2Division of Pediatric Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouv.
Insights
Surgical interventions for pediatric unilateral vocal cord paralysis, including reinnervation, injection laryngoplasty, and thyroplasty, show promising results. Laryngeal reinnervation appears most effective for dysphonia, while injection laryngoplasty is safe and effective, and thyroplasty aids aspiration.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Speech and Voice Science
Background:
- Pediatric unilateral vocal cord paralysis (UVCP) requires surgical intervention, with common procedures including injection laryngoplasty, thyroplasty, and laryngeal reinnervation.
- Despite increased interest, robust surgical outcomes data for pediatric UVCP remain limited.
Purpose of the Study:
- To systematically review and synthesize existing evidence on the efficacy and safety of surgical strategies for pediatric UVCP.
Main Methods:
- A comprehensive literature search of MEDLINE and EMBASE (1946-2014) was conducted for studies on laryngoplasty, thyroplasty, or laryngeal reinnervation in pediatric UVCP.
- Study quality, evidence level, and risk of bias were independently assessed by two reviewers, who also extracted data on UVCP etiology, voice, swallowing, and adverse events.
Main Results:
- Fifteen studies (6 observational, 6 case series, 3 case reports) involving 36 children were included.
- Laryngeal reinnervation (8 studies) showed improvement or resolution of dysphonia in all 36 children.
- Injection laryngoplasty (6 studies) improved voice quality, speech, swallowing, and glottic closure in most of the 31 children treated.
- Thyroplasty (5 studies) in 12 children resulted in dysphonia resolution or improvement in 6, with 7 of 8 patients experiencing improved aspiration.
Conclusions:
- Laryngeal reinnervation may be the most effective surgical option for pediatric dysphonia, though long-term data are needed.
- Injection laryngoplasty is a safe, effective, and non-permanent choice for most children with dysphonia.
- Thyroplasty, while less favored due to anesthetic challenges, remains a viable option for managing aspiration in pediatric UVCP.
Importance:
The most widely used surgical interventions for pediatric unilateral vocal cord paralysis include injection laryngoplasty, thyroplasty, and laryngeal reinnervation. Despite increasing interest in surgical interventions for unilateral vocal cord paralysis in children, the surgical outcomes data in children are scarce.
Objective:
To appraise and summarize the available evidence for pediatric unilateral vocal cord paralysis surgical strategies.
Evidence Review:
MEDLINE (1946-2014) and EMBASE (1980-2014) were searched for publications that described the results of laryngoplasty, thyroplasty, or laryngeal reinnervation for pediatric unilateral vocal cord paralysis. Further studies were identified from bibliographies of relevant studies, gray literature, and annual scientific assemblies. Two reviewers independently appraised the selected studies for quality, level of evidence, and risk of bias as well as extracted data, including unilateral vocal cord paralysis origin, voice outcomes, swallowing outcomes, and adverse events.
Findings:
Of 366 identified studies, the inclusion criteria were met by 15 studies: 6 observational studies, 6 case series, and 3 case reports. All 36 children undergoing laryngeal reinnervation (8 studies) had improvement or resolution of dysphonia. Of 31 children receiving injection laryngoplasty (6 studies), most experienced improvement in voice quality, speech, swallowing, aspiration, and glottic closure. Of 12 children treated by thyroplasty (5 studies), 2 experienced resolution of dysphonia, 4 had some improvement, and 4 had no improvement (2 patients had undocumented outcomes). Thyroplasty resolved or improved aspiration in 7 of 8 patients.
Conclusions And Relevance:
Published studies suggest that reinnervation may be the most effective surgical intervention for children with dysphonia; however, long-term follow-up data are lacking. With the exception of polytetrafluoroethylene injections, injection laryngoplasty was reported to be a relatively safe, nonpermanent, and effective option for most children with dysphonia. Thyroplasty appears to have fallen out favor in recent years because of difficulty in performing this procedure in children under local anesthesia, but it continues to be a viable option for children with aspiration.
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