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Evaluation of thyroplasty with cartilage implant in young children
Pierre Fayoux1, Alix Maltezeanu2, Pierre-Emmanuel Lemesre2
1CHU Lille, Department of Pediatric Otolaryngology- Head Neck Surgery, Jeanne de Flandre Hospital, F-59000, Lille, France; Univ. Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, F-59000, Lille, France.
Insights
Thyroplasty using autologous cartilage implants shows stable voice and swallowing improvements in young children, with no implant resorption observed. This technique offers a reliable option for pediatric vocal fold medialization, especially when other methods fail.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Vocal Cord Dysfunction
Background:
- Pediatric vocal fold paralysis presents unique challenges for surgical intervention.
- Thyroplasty aims to improve voice and swallowing by medializing the vocal fold.
- Autologous cartilage implants offer a potential solution for stable vocal fold positioning.
Purpose of the Study:
- To evaluate the efficacy and safety of thyroplasty with autologous cartilage implants in children under 10 years old.
- To assess long-term functional and morphological outcomes after pediatric thyroplasty.
Main Methods:
- Retrospective review of 11 patients (<10 years) undergoing thyroplasty with cartilage implants (1999-2019).
- Postoperative follow-up of at least one year, including fiberoptic laryngoscopy and laryngeal ultrasound.
- Functional assessment via parental visual analogue scale for laryngeal signs and Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale for dysphonia.
Main Results:
- Significant improvements in voice and reduction in aspiration and chronic congestion observed post-surgery.
- Stable results maintained in 10 out of 11 patients over a median follow-up of 77 months.
- No implant resorption or thyroid cartilage deformation noted on ultrasound; one patient required a secondary procedure.
Conclusions:
- Thyroplasty with autologous cartilage is a safe and effective procedure for pediatric vocal fold medialization.
- Cartilage implants provide stable vocal fold positioning during growth, relevant for cases with contraindications to reinnervation.
- Technical adaptations are necessary for successful pediatric thyroplasty.
Objective:
To evaluate thyroplasty with autologous cartilage implant in young children.
Methods:
This retrospective study included all patients aged <10 years who underwent thyroplasty, in a tertiary care center, between 1999 and 2019 and had a postoperative follow-up at least one year later. Morphological evaluation was based on fiberoptic laryngoscopy and laryngeal ultrasound. Functional outcomes included parental evaluation of laryngeal signs by visual analogue scale and dysphonia ratings on the Grade, Roughness, Breathiness, Asthenia, and Strain scale. These assessments were performed at postoperative months 1, 6, and 12, and then annually.
Results:
Participants were 11 patients with a median age of 26 months (8-115 months). Their median duration of progression of paralysis before surgical management was 17 months. No intra or postoperative complications were observed. Postoperative evaluation showed virtual disappearance of aspiration and chronic congestion. Voice evaluation revealed significant improvements in all patients. The long-term trend, over a median of 77 months, showed stable results in 10 cases. One patient had late-onset deterioration requiring an additional vocal fold injection. Ultrasound follow-up showed no resorption of the cartilage implant and no deformation of the thyroid ala.
Conclusion:
Pediatric thyroplasty requires technical adaptations. Use of a cartilage implant allows observation of medialization stability during the growth. These findings are particularly relevant of contraindication or failure of nonselective reinnervation.
