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Endoscopic coblation-assisted and partial arytenoidectomy for infants with idiopathic bilateral vocal cord paralysis

Letian Tan1, Chao Chen, Qi Li

  • 1Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Fudan University, Shanghai, China.

Medicine
|January 28, 2022
PubMed

Insights

Endoscopic coblation-assisted and partial arytenoidectomy (ECPA) shows promise for infants with idiopathic bilateral vocal cord paralysis (BVCP). This procedure offers a viable alternative to tracheostomy, especially in infants without other airway issues.

Area of Science:

  • Otolaryngology
  • Pediatric Surgery
  • Laryngology

Background:

  • Idiopathic bilateral vocal cord paralysis (BVCP) in infants presents significant management challenges.
  • Current treatment options for BVCP often involve invasive procedures like tracheostomy.
  • There is a need for effective, less invasive surgical interventions.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of endoscopic coblation-assisted and partial arytenoidectomy (ECPA) in treating idiopathic BVCP in infants.
  • To assess surgical success rates, voice quality, and swallowing function post-ECPA.
  • To compare outcomes in infants with isolated BVCP versus those with co-existing airway abnormalities.

Main Methods:

  • Retrospective analysis of 33 infants diagnosed with idiopathic BVCP.
  • All infants underwent endoscopic coblation-assisted and partial arytenoidectomy (ECPA).
  • Data collected included surgical success, swallowing function, voice outcomes, and follow-up duration (>33 months).

Main Results:

  • Overall surgical success rate for ECPA was 87.9% (29/33 infants).
  • Success rates varied by surgical approach: 90.5% for unilateral and 33.3% for bilateral ECPA.
  • Infants with isolated BVCP had a higher success rate (95.6%) compared to those with additional airway issues (70.0%).
  • Post-operative swallowing difficulties were noted in 5 infants; 12 showed vocal cord recovery and satisfactory voice. Early granuloma formation resolved spontaneously in 5 cases.

Conclusions:

  • Endoscopic coblation-assisted and partial arytenoidectomy (ECPA) is a promising surgical option for infants with idiopathic BVCP.
  • ECPA demonstrates favorable outcomes, including vocal cord function and voice quality, with a lower complication rate compared to tracheostomy.
  • The procedure is particularly effective in infants without concurrent airway abnormalities, offering a potential alternative to initial tracheostomy placement.

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