Endoscopic percutaneous suture lateralization for neonatal bilateral vocal fold immobility

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Neonatology

Background:

• Bilateral vocal-fold immobility (BFVI) presents a significant airway challenge in neonates, often necessitating invasive interventions.
• Current treatments aim to secure the airway while mitigating risks like aspiration and voice impairment.

Purpose of the Study:

• To evaluate the outcomes of a novel percutaneous endoscopic suture lateralization technique for neonatal BFVI.
• To assess the safety and efficacy of this non-destructive approach in managing neonatal airway obstruction.

Main Methods:

• A retrospective case series involving 6 neonates diagnosed with BFVI.
• The procedure involved percutaneous needle-directed placement of sutures under spontaneous-breathing laryngoscopy.
• A novel technique using 4-0 prolene suture without specialized equipment was employed.

Main Results:

• All 6 neonates showed clinical improvement in stridor and respiratory distress, avoiding tracheostomy.
• 5 out of 5 surviving neonates were successfully weaned off respiratory support, fed orally without aspiration, and breathing room air at follow-up.
• 4 out of 5 patients experienced partial or complete vocal-fold function recovery; one patient had transient aspiration resolved by suture removal.

Conclusions:

• Percutaneous endoscopic suture lateralization offers a safe and effective non-destructive primary treatment for neonatal BFVI.
• This technique successfully establishes adequate airway patency, preventing the need for tracheotomy in affected neonates.