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[Neonatal laryngeal paralysis. Course and treatment. 56 cases (author's transl)]
Insights
Neonatal laryngeal paralysis, often caused by obstetric trauma or neurological issues, typically resolves by six months. Even persistent cases show good tolerance, with surgery reserved for a few.
Area of Science:
- Pediatric Otolaryngology
- Neonatal Neurology
- Congenital Disorders
Context:
- Laryngeal paralysis in newborns presents a significant clinical challenge.
- Understanding the diverse etiologies and prognoses is crucial for effective management.
Purpose:
- To analyze the causes, clinical course, and treatment outcomes of neonatal laryngeal paralysis.
- To evaluate the long-term tolerance of persistent laryngeal paralysis.
Summary:
- This study reviewed 56 cases of neonatal laryngeal paralysis (1970-1976), identifying causes including obstetric trauma (11), nuclear agenesis (7), neurological disorders (13), and congenital heart disease (3).
- Regression occurred by six months in obstetric and isolated cases; neurological causes often persisted but were generally well-tolerated.
- Initial management involved intubation; tracheotomy was not required. Surgical intervention (arytenoidectomy/opexy) was performed in 5 cases.
Impact:
- Provides insights into the varied etiologies and natural history of neonatal laryngeal paralysis.
- Highlights the generally favorable prognosis and good tolerance of persistent forms, guiding clinical decision-making.
- Informs treatment strategies, emphasizing conservative management and selective surgical intervention.
Abstract:
56 laryngeal paralyses were seen in newborn infants between 1970 and 1976 (25 bilateral, 31 unilateral). The aetiology was obstetric trauma in 11 cases, nuclear agenesis in 7 cases, a severe neurological disorder (spina bifida, hydrocephaly, microcephaly, lesions of the central nervous system) in 13 cases, and congenital heart disease in 3 cases. In 10 cases, the paralysis was present in isolation. The initial state was not recorded in 11 cases. The course varied according to the aetiology: 5 deaths, 4 due to the severity of neurological problems. Regression, which invariably occured before the end of the 6th month, was seen in all the cases with an obstetric aetiology and in 50% of those in which the paralysis was present in isolation. There was persistence in the majority of neurological, nuclear or central causes. However, subsequent tolerance of persistent forms was good in all those patients followed-up on a regular basis, apart from 5 who underwent surgery. Treatment consisted of intubation for forms poorly tolerated initially, for the first few weeks. Tracheotomy did not prove necessary in any case. 5 patients underwent surgery: arytenoidectomy or arytenoidopexy via an extralaryngeal approach.