Flexible Laryngoscopy Research Articles

Injection laryngoplasty in pediatrics

Injection laryngoplasty is a procedure that provides support to a vocal fold that lacks either the bulk or the mobility it once had. Two indications are vocal fold immobility from vocal fold paralysis, scarring, or atrophy among other causes or glottic insufficiency resulting from vocal atrophy, sulcus vocalis, or vocal fold neoplasm. A comprehensive pre-operative work up includes evaluation of the vocal folds by indirect flexible laryngoscopy, stroboscopy, direct operative laryngoscopy, and/or ultrasound. Measuring impacts of vocal pathology that may be suited to injection laryngoplasty is done through pediatric reported outcome measures of voice and evaluation of swallow. During the operation the surgeon can choose from different injection materials depending on the need of the procedure. In children, the most typical method of delivery in children is under direct or telescopic and/or microscopic visualization during a procedure under anesthesia. The surgeon must take caution for proper placement of material in relation to the true vocal fold to reduce risks of voice dysfunction, airway obstruction, airway hemorrhage, or injury to the adjacent laryngeal structures. Injection laryngoplasty is the preferred method of surgical management of vocal fold immobility and has proven safe in children of all ages. Injection laryngoplasty is a procedure that provides support to a vocal fold that lacks either the bulk or the mobility it once had. Two indications are vocal fold immobility from vocal fold paralysis, scarring, or atrophy among other causes or glottic insufficiency resulting from vocal atrophy, sulcus vocalis, or vocal fold neoplasm. A comprehensive pre-operative work up includes evaluation of the vocal folds by indirect flexible laryngoscopy, stroboscopy, direct operative laryngoscopy, and/or ultrasound. Measuring impacts of vocal pathology that may be suited to injection laryngoplasty is done through pediatric reported outcome measures of voice and evaluation of swallow. During the operation the surgeon can choose from different injection materials depending on the need of the procedure. In children, the most typical method of delivery in children is under direct or telescopic and/or microscopic visualization during a procedure under anesthesia. The surgeon must take caution for proper placement of material in relation to the true vocal fold to reduce risks of voice dysfunction, airway obstruction, airway hemorrhage, or injury to the adjacent laryngeal structures. Injection laryngoplasty is the preferred method of surgical management of vocal fold immobility and has proven safe in children of all ages.

Oral Premalignant and Malignant Lesions in Fanconi Anemia Patients.

There is a lack of data supporting cancer surveillance in pediatric Fanconi Anemia patients. We sought to describe the rates of upper aerodigestive lesions and malignancy in this population to augment current management guidelines. A retrospective cohort study of patients with Fanconi Anemia from a quaternary referral center between 2007-2021 was completed for head and neck cancer risk. One hundred and five FA patients were reviewed. Average age at presentation was 11.3 years old and 90.5% of patients underwent hematopoietic stem cell transplant (HSCT). A total of 8.6% of patients had leukoplakia or erythroplakia and 3.8% developed malignancy. The standardized incidence ratio of head and neck malignancy was 483.8. Patients presented with leukoplakia and malignancy at an average age of 14.6 and 25.1 years old, respectively. Malignancies were aggressive and marked by recurrence. There were no premalignant or malignant lesions found on flexible laryngoscopy. This series represents the largest longitudinal series of pediatric FA head and neck lesions. Fanconi Anemia patients should begin screening for head and neck cancer at age 10 or after HSCT. Level 4 Laryngoscope, 133:1745-1748, 2023.

Long-term Outcomes of Vocal Fold Paralysis Following Patent Ductus Arteriosus Ligation in Neonates.

In patients undergoing patent ductus arteriosus (PDA) ligation there is a significant risk of left vocal fold paralysis (LVFP) particularly in premature neonates who are small for gestational age. The objective of this study is to determine the incidence of LVFP in infants following PDA ligation and report on long-term outcomes in patients with LVFP. We performed a prospective study of patients undergoing PDA ligation in the newborn intensive care unit (NICU) between April 2004 and May 2014. Following PDA ligation, flexible laryngoscopy was performed to assess vocal fold mobility. Patients were then followed longitudinally to determine long-term outcomes. A total of 163 infants underwent PDA ligation. Thirty-six patients (22%) developed LVFP following the procedure. Twenty-five percent of neonates <1500 g experienced LVFP versus 5% of patients >1500 g (p=0.033). Patients with LVFP were more likely to require a feeding tube (64% vs. 19.6%; p < 0.05) and spent more time in the NICU (135 days vs. 106 days; p < 0.05). Twenty-four patients received long-term follow-up. Six (25%) had complete resolution of LVFP, 10 (42%) were compensated, and 8 (33%) demonstrated persistent LVFP with no improvement. The incidence of LVFP after PDA ligation is high especially in extremely low birth weight children. The majority of patients recovered well with time, but further surgical intervention was required in uncompensated cases. Long-term follow-up of these patients is needed to ensure improvement. Laryngoscope, 133:1257-1261, 2023.

512 Megaoesophagus Presenting as Stridor: A Case Report and Review of Literature

Abstract Introduction Megaoesophagus, dilatation of the oesophagus, is a recognised late complication of achalasia cardia, Chagas disease and, less commonly, dysmotility disorders. Megaoesophagus often presents with dysphagia, regurgitation of food and chest pain. Here, we describe a case of a patient presenting with stridor secondary to chronic dysmotility in the absence of dysphagia. Case Report An 85-year-old female presented to the Emergency Department with stridor, and a history of breathlessness and intermittent coughing episodes. Flexible laryngoscopy revealed the larynx to be rotated to the right, corresponding with a palpable swelling of the left neck. A chest X-ray showed a markedly dilated oesophagus. Computed tomography revealed severe oesophageal dilatation causing compression of the tracheobronchial tree and larynx. The patient received nebulised adrenaline and intravenous dexamethasone, resulting in resolution of her stridor. A barium swallow demonstrated marked cricopharyngeal spasm causing significant luminal narrowing but no holdup of barium. The remainder of the oesophagus was chronically dilated to the gastro-oesophageal junction and appeared atonic. The findings were atypical of achalasia, there were no obstructing lesions identified and chronic dysmotility was considered most likely, which was subsequently confirmed by a gastroenterology opinion. Discussion Megaoesophagus is rare, most frequently presents with dysphagia and regurgitation of food and is most commonly caused by achalasia. A literature search identified only one previous case of obstructing megaoesophagus secondary to idiopathic dysmotility disorder; however, this case revealed the stridor to be secondary to an impacted food bolus, whereas our case did not demonstrate any obstructing lesions.

Consultations for Foreign Bodies in Aerodigestive Tract: Assessment of Diagnostic Modalities.

To evaluate test characteristics of various diagnostic modalities in the workup of foreign body (FB) sensation in the aerodigestive tract. Database containing all inpatient otolaryngology consultations between 2008 and 2020 was used. Cases of FB sensation were identified by documented encounter diagnosis or hospital problem of FB or globus sensation. Variables including basic patient demographics, clinical presentations, diagnostic imaging modalities, procedures, and outpatient follow-up were collected. One hundred and six patients were included in the study. A FB was visualized in 55 patients (52%) and removed in 52 patients (49%); 3 patients had a FB that was visualized initially but not found in the operating room. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were found to be 41%, 50%, 58%, and 33%, respectively, for X-ray (XR); 91%, 61%, 70%, and 87%, respectively, for computed tomography (CT). Sensitivity and NPV were 25% and 57%, respectively, for flexible fiberoptic laryngoscopy (FFL). Seventy-one of 106 patients (67%) underwent invasive interventions during their workup for FBs. Ten out of 11 (91%) chicken bones were found in the digestive tract compared to 7 out of 19 (37%) fishbones (p=0.0046). In patients with history of FB ingestion, CT may be more beneficial than XR as a screening tool for locating foreign bodies and guiding further management. FFL alone is inadequate for ruling out a FB in the aerodigestive tract given FB's high likelihood of being in the esophagus or buried in soft tissue or mucosa. 3 Laryngoscope, 133:1361-1366, 2023.

Observations of increased gastroesophageal reflux symptomology in an anhydrous ammonia exposed population

ObjectiveThis case series describes a cohort of patients exposed to anhydrous ammonia vapors with clinical findings of laryngopharyngeal reflux (LPR). The study characterizes the identification of LPR as a consequence of vapor inhalation and the utility of PPI therapy in LPR secondary to inhalational ammonia exposure. MethodsThis is a case series of 15 patients exposed to anhydrous ammonia from a single chemical spill who experienced LPR several months after exposure. Symptoms of LPR were assessed at their initial consultation and by phone at least 30 days after treatment with low-dose PPI or diet modification. At this visit, patients underwent complete head and neck examination and flexible direct laryngoscopy. Results15 patients were available for analysis before and after treatment. 93.3 % experienced at least three cardinal symptoms of LPR. 66 % of these patients had at least one LPR finding on flexible laryngoscopy. 73 % were treated with daily standard dose PPI, and 82 % of these patients experienced reduction of symptoms after 30 days of PPI treatment. Four of 15 patients were not taking the PPI as prescribed, and only one of these patients had resolution of LPR symptoms. ConclusionWe conclude that there is an association between anhydrous ammonia exposure and the development of LPR symptoms. In this study, treatment with PPIs was successful in reducing symptoms for most patients, and patients who did not receive PPIs experienced symptoms for a longer time.

Historical Review and Modern Case of Spontaneous Laryngeal Abscess.

Laryngeal abscesses are rare in the modern antibiotic era. Historically, they were associated with systemic infections including typhoid fever, measles, gonorrhea, syphilis, and tuberculosis. More recent authors have described cases resulting from iatrogenic injury and immunosuppression. This report presents a novel case of laryngeal abscess in the setting of uncontrolled diabetes and a detailed review of modern, reported cases of spontaneous laryngeal abscess. Report of a single case. Also, PubMed was queried for cases of laryngeal abscess since 1985. A 58-year-old male with poorly controlled diabetes presented with odynophagia, dysphagia, and dyspnea. He had biphasic stridor, and flexible laryngoscopy showed reduced mobility of bilateral vocal folds and narrowed glottic airway. He was taken urgently for awake tracheostomy and microdirect laryngoscopy. Laryngoscopy demonstrated fullness and fluctuance of the right hemilarynx. The abscess cavity was entered endoscopically via paraglottic incision extending into the subglottis. The patient was treated with an 8-week course of ampicillin-sulbactam with resolution of infection. Seven additional cases of spontaneous laryngeal abscesses published after 1985 were identified. In total, 6 of 8 had some form of immunodeficiency (75%). The most common presenting symptoms were dysphonia (8/8, 100%), odynophagia (5/8, 62.5%), and dyspnea/stridor (4/8, 50%). All cases were treated with surgical incision and drainage. Laryngeal abscesses are rare in the era of modern antibiotics. This review confirms that the majority of recent episodes occurred in the setting of immunodeficiency and are caused by non-tubercular bacteria. These infections are commonly associated with impaired vocal fold mobility which may contribute to dyspnea, stridor, and airway compromise. Surgical intervention is necessary for treatment and culture-directed antimicrobial therapy. Poorly controlled diabetes is a newly described context for development of spontaneous laryngeal abscess.

Impact of a postgraduate year one (PGY-1) otolaryngology bootcamp on procedural skill development

Background: To measure the impact of an intensive eight-week postgraduate year one (PGY-1) otolaryngology bootcamp on the acquisition and retention of otolaryngology residents’ procedural skills compared to the traditional method of skill acquisition through clinical exposure. Methods: Residents at our institution were evaluated on their performance of flexible laryngoscopy, suture ligature, and rigid bronchoscopy setup at three time points: pre-bootcamp, one-week post-bootcamp, and one-year post-bootcamp. Video recordings were scored by two blinded faculty reviewers using a multipoint rating system. A control group of rising postgraduate year two (PGY-2) residents who did not participate in bootcamp were recorded performing these same skills. Scores in the three skills were compared between groups via t-tests. The eight-week bootcamp curriculum for PGY-1s was held at the Montefiore Einstein Center for Innovation in Simulation at Albert Einstein College of Medicine/Montefiore Medical Center. The participants were two classes of PGY-1 residents (n=8) at our institution who participated in a bootcamp at the beginning of residency, and one class of rising PGY-2 residents (n=3) who did not participate in a bootcamp (control group). Results: A comparison of pre-bootcamp scores to one-week post-bootcamp scores showed significant improvement in suture ligature ( P<0.05) and rigid bronchoscopy ( P<0.05), but no difference in flexible laryngoscopy ( P=0.54). Suture ligature ( P=0.09) and rigid bronchoscopy ( P=0.25) skills were not significantly different from one-week post-bootcamp to one-year post-bootcamp; however, a significant skill improvement was observed in flexible laryngoscopy ( P<0.05). By June of PGY1 year, the two bootcamp cohorts were similar to controls in all three skills: flexible laryngoscopy ( P=0.05), rigid bronchoscopy ( P=0.26), and suture ligature ( P=0.10). Conclusions: Participation in PGY-1 bootcamp was associated with improved acquisition and short-term retention of basic procedural skills, suggesting that bootcamps can be an effective arena to teach basic skills in otolaryngology. PGY-1 bootcamp is a promising arena for multi-institutional development.

Management of paediatric laryngotracheal trauma.

To summarise and describe the clinical presentations, diagnostic approaches and airway management techniques in children with laryngotracheal trauma. The clinical data related to laryngotracheal trauma diagnosed and treated at the Beijing Children's Hospital, between January 2013 and July 2018, were retrospectively reviewed. Disease diagnosis, treatment, management and outcomes were analysed. A total of 13 cases were enrolled, including 7 cases of penetrating laryngotracheal trauma. The six cases of blunt laryngotracheal trauma were caused by collisions with hard objects. In all cases, voice, airway and swallowing outcomes were graded as 'good', except for one patient who had residual paralysis of the vocal folds. Flexible fibre-optic laryngoscopy and computed tomography can play an important role in diagnosing laryngotracheal trauma. The airway should be secured and, if necessary, opened by tracheal intubation or tracheostomy.

Impact of a postgraduate year one (PGY-1) otolaryngology bootcamp on procedural skill development.

Background: To measure the impact of an intensive eight-week postgraduate year one (PGY-1) otolaryngology bootcamp on the acquisition and retention of otolaryngology residents' procedural skills compared to the traditional method of skill acquisition through clinical exposure. Methods: Residents at our institution were evaluated on their performance of flexible laryngoscopy, suture ligature, and rigid bronchoscopy setup at three time points: pre-bootcamp, one-week post-bootcamp, and one-year post-bootcamp. Video recordings were scored by two blinded faculty reviewers using a multipoint rating system. A control group of rising postgraduate year two (PGY-2) residents who did not participate in bootcamp were recorded performing these same skills. Scores in the three skills were compared between groups via t-tests. The eight-week bootcamp curriculum for PGY-1s was held at the Montefiore Einstein Center for Innovation in Simulation at Albert Einstein College of Medicine/Montefiore Medical Center. The participants were two classes of PGY-1 residents (n=8) at our institution who participated in a bootcamp at the beginning of residency, and one class of rising PGY-2 residents (n=3) who did not participate in a bootcamp (control group). Results: A comparison of pre-bootcamp scores to one-week post-bootcamp scores showed significant improvement in suture ligature ( P<0.05) and rigid bronchoscopy ( P<0.05), but no difference in flexible laryngoscopy ( P=0.54). Suture ligature ( P=0.09) and rigid bronchoscopy ( P=0.25) skills were not significantly different from one-week post-bootcamp to one-year post-bootcamp; however, a significant skill improvement was observed in flexible laryngoscopy ( P<0.05). By June of PGY1 year, the two bootcamp cohorts were similar to controls in all three skills: flexible laryngoscopy ( P=0.05), rigid bronchoscopy ( P=0.26), and suture ligature ( P=0.10). Conclusions: Participation in PGY-1 bootcamp was associated with improved acquisition and short-term retention of basic procedural skills, suggesting that bootcamps can be an effective arena to teach basic skills in otolaryngology. PGY-1 bootcamp is a promising arena for multi-institutional development.

A case of vocal cord dysfunction in the emergency department

We describe the case of a 78-year-old woman admitted to our emergency department for an acute onset of severe dyspnoea with inspiratory wheezing-like sounds. She denied fever, cough, voice change and pain. She referred a similar but less severe episode occurred spontaneously one year before, with complete resolution in few minutes without sequelae. On examination upper airway obstruction was firstly excluded. She was initially treated as having asthma, without response. Parenteral high dose corticosteroids and antihistamines provided no benefit. Point-of-care-ultrasound resulted normal. Flexible laryngoscopy during the episode showed paradoxical vocal cord movement with adduction during both inspiration and expiration. This demonstrated that her dyspnoea was from Vocal Cord Dysfunction (VCD). VCD completely solved after administration of intravenous benzodiazepines.

Woman With Voice Changes and Cough

A 67-year-old woman with longstanding tobacco use presented to the emergency department with a persistent cough, difficulty in phonation worsening over several weeks, hoarseness, and a globus sensation. Her vital signs were normal, but she had audible stridor with an otherwise normal oropharyngeal examination. The emergency physician performed bedside transcutaneous laryngeal ultrasound of the patient’s vocal cords (Figure 1), and the otolaryngologist confirmed the diagnosis with flexible fiberoptic laryngoscopy (Figure 2 and Video E1 [available at http://www.annemergmed.com]).

Vocal cord dysfunction after pediatric cardiac surgery: A prospective implementation study

ObjectiveTo determine the incidence, outcomes, and evaluate diagnostic modalities for postoperative vocal cord dysfunction (VCD) following cardiothoracic surgery in children. MethodsA prospective mixed-methods study using principles of implementation science was completed. All patients undergoing surgery involving the aortic arch, ductus, or ligamentum arteriosum and vascular rings from September 2019 to December 2020 were enrolled. Patients underwent speech pathology assessment, laryngeal ultrasound, and flexible direct laryngoscopy. ResultsNinety-five patients were eligible for inclusion. The incidence of VCD ranged from 18% to 56% and varied according to procedure group. VCD occurred in 42% of neonates. Repair of hypoplastic aortic arch was associated with increased risk of VCD (57%; P = .002). There was no significant difference in duration of intubation, pediatric intensive care unit stay, or hospital stay. Forty percent children were able to achieve full oral feeding. Children with VCD were more likely to require nasogastric supplementary feeding at discharge (60% vs 36%; P = .044). Sixty-eight percent of patients demonstrated complete resolution of VCD at a median of 97 days postoperatively. Laryngeal ultrasound and speech pathology assessment combined had a sensitivity of 91% in comparison to flexible direct laryngoscopy. ConclusionsVCD occurred in one-third and resolved in two-thirds of patients at a median of 3 months following cardiac surgery. Aortic arch repair carried the highest risk of VCD. VCD adversely influenced feeding. Forty percent of patients achieved full oral feeding before discharge. VCD did not delay intensive care unit or hospital discharge. Speech pathology assessment and laryngeal ultrasound combined was reliable for diagnosis in most patients and was more patient friendly than flexible direct laryngoscopy.

Quantification and visualization of aerosols in ear, nose, and throat exam and flexible laryngoscopy.

ObjectiveTo measure and visualize aerosol generation during ear, nose, and throat (ENT) exam and flexible laryngoscopy, as safety recommendations are currently to defer routine and low‐priority examinations.MethodsAerosols generated during ENT examination and flexible laryngoscopy were quantified by laser aerosol spectrometry and visualized live by high‐speed imaging during those procedures for three participants who were tested three times for each test.ResultsRoutine ENT examination and flexible laryngoscopy produce aerosols at levels comparable to normal breathing and speech.ConclusionDuring ENT examination and flexible laryngoscopy, the practitioner should wear a surgical mask and potentially contaminated surfaces should be cleaned after the procedure. For flexible laryngoscopy, it is recommended in addition that the patient wear a mask over the mouth in case the procedure induces a sneeze. The time during which the patient is unmasked should be minimized. In these settings, the risk to the practitioner is minimal unless the patient is sneezing or symptomatic.Level of Evidence1

Feasibility and accuracy of laryngeal ultrasound for the assessment of vocal cord mobility in children

ObjectiveTranscutaneous laryngeal ultrasonography has been utilized to document vocal cord mobility in the adult perioperative thyroidectomy setting with variable success. The aims of this study were to assess the feasibility of using transcutaneous ultrasound in vocal cord visualization in children, to determine the accuracy in detecting vocal cord immobility compare to flexible laryngoscopy, and to identify any barriers that may affect its utility. MethodsThis is a prospective blinded-assessor study. Transcutaneous laryngeal ultrasound and flexible laryngoscopy were performed in two pediatric settings: perioperative thyroid surgery and inpatient consultation for airway, voice, or swallowing concerns. The video recordings of ultrasound and laryngoscopy were assessed by two fellowship-trained pediatric otolaryngologists independently. ResultsA total of 83 paired laryngoscopy and ultrasound assessments were performed, 39 for perioperative thyroidectomy and 44 for inpatient consultation. The majority had normal vocal cord mobility (65/83, 78%), while 16 had unilateral cord palsy and 2 had bilateral palsy. The vocal cords were successfully visualized on ultrasound in 82/83 (99%) evaluations. Compared to gold standard laryngoscopy, the sensitivity for diagnosing vocal cord palsy on ultrasound was 53–83%, and the specificity was 97–98%. The sensitivity for detecting asymmetric vocal cord movement was 56–88%, and the specificity was 99%. The agreement between ultrasound and laryngoscopy diagnoses were 87–94% (κ = 0.58–0.83, moderate to near perfect agreement). The intra-rater agreement was 95–100% (κ = 0.64–1.0), and inter-rater agreement was 90% (κ = 0.66). Both subjects with bilateral vocal cord palsy had incorrect ultrasound diagnoses by both observers. ConclusionWe were able to utilize transcutaneous laryngeal ultrasound to successfully visualize vocal cord mobility in almost all pediatric patients with a high degree of specificity. The modality has limitations in the assessment of bilateral vocal cord palsy, and its sensitivity was observer-dependent. Level of evidence4.

Audit of flexible laryngoscopy use and decontamination using a chlorine dioxide wipe system during COVID-19: Assessing the risk of disease transmission

SummaryAimTo assess the efficiency of decontamination of flexible nasoendoscopes using a chlorine dioxide wipe system and assessing the risk of disease transmission during the COVID-19 pandemic.MethodProspective and retrospective review of 544 patient episodes of nasoendoscopy and a study of 41 patient procedures and 22 members of staff at an ENT Outpatient Department from September 2020 to March 2021.ResultsAmong 41 randomly selected episodes of nasoendoscopy in the clinic, there was 93%–100% compliance with decontamination guidelines suggested by ENT UK. Among 544 patients who had nasoendoscopies, 20 had RT-PCR tests within two weeks and all yielded a negative result; no clusters of consecutive endoscopies were noted. None among the 22 clinic staff had symptoms of COVID-19 infection during the study period.ConclusionAccepting the limitations of the study design, this audit found no evidence of nosocomial transmission of SARS-CoV-2 virus related to use or reprocessing of flexible nasoendoscopes among patients and staff following good compliance to ENT UK decontamination guidelines.

Using Intra-Operative Laryngeal Ultrasonography as a Real-Time Tool in Assessing Vocal Cord Function During Radiofrequency Ablation of the Thyroid Gland.

Inadvertent injury of the recurrent laryngeal nerve can occur during radiofrequency ablation (RFA) of thyroid nodules. Methods to avoid permanent injury have not been described. Laryngeal ultrasonography (LUSG) can assess the function of vocal cords (VCs) in real time. The present study aimed to evaluate the feasibility and accuracy of LUSG in assessing real-time VC function during RFA of benign thyroid nodules. Consecutive patients undergoing RFA for benign thyroid nodules under local anesthesia were included. Spontaneous VC movements were checked with intra-operative LUSG (iLUSG) following each transverse ablation plane. In case of reduced VC movement, the ablation was stopped immediately. Post-ablation VC function was rechecked by LUSG on day-0 and flexible laryngoscopy (FL) on day-7. A concordance with day-0 LUSG or day-7 FL was a "true positive" or "true negative" depending on the presence or absence of VC palsy (VCP). Accuracy was calculated as the sum of all true positives and negatives divided by total nerves-at-risk. Of 65 eligible patients, 56 (86.2%) were females. Twelve (18.5%) patients had bilateral lobe RFA, while 53 (81.5%) had unilateral RFA. The total number of nerves-at-risk was 77. Three unilateral VCPs (3.9%) were initially detected on iLUSG and confirmed by day-0 LUSG. All recovered fully within one week. The overall accuracy of iLUSG was 100%. iLUSG is a highly accurate method that permits real-time feedback on the function of the VCs during RFA procedure. Real-time detection of VCP may prevent permanent injury. Methodological routine use of iLUSG is recommended during thyroid RFA.

Long term outcome of laryngeal mobility disorder and quality of life after pediatric cardiac surgery

IntroductionLaryngeal mobility disorder after a pediatric heart surgery is common (between 5 and 10% of cases), and has important consequences on swallowing, breathing and speaking. After reviewing the literature, the recovery rate is variable and the postoperative follow-up is often done on a short time frame. The primary objective of the study is to describe the recovery from laryngeal mobility disorder with a follow-up time of at least 5 years. The secondary objective is to describe of the quality of life of the child in terms of phonation and swallowing, and to identify potential risk factors for a lasting laryngeal mobility disorder. MethodsWe collected data (morphological characteristics and details of the procedures and medical care) on children who had undergone a heart surgery with risks of complications, between 2010 and 2015, and with a laryngeal mobility disorder detected after the surgery through nasal flexible laryngoscopy. During a follow-up consultation, carried at least 5 years after the surgery, we performed a nasal flexible laryngoscopy to assess whether or not the patient had recovered a full mobility of the larynx. Two questionnaires were also given to the patients, the pVHI and the PEDI EAT-10, to assess respectively the quality of their speech and of their swallowing function. ResultsThe recovery rate for a laryngeal mobility disorder more than 5 years after surgery was found to be 65% (9 children out of the 14 included in the study). We identified a risk factor for the persistence of a laryngeal mobility disorder after surgery: the presence of an associated genetic syndrome, p = 0.025. Children with persistent laryngeal mobility disorder have an impaired quality of life score, using the pVHI scale, which correlates well with the flexible laryngoscopy findings, p = 0.033. ConclusionChildren with a lasting laryngeal mobility disorder have disabling respiratory and vocal symptoms in their daily lives. Nasal flexible laryngoscopy should therefore be systematically performed postoperatively after a surgery carrying risks. For improved patient management, early detection of these disorders by pharyngolaryngeal nasal flexible laryngoscopy in the aftermath of high-risk cardiac surgery is strongly advised, with prolonged follow-up.

A Case of Migrated Esophageal Foreign Body Removal Through Cervical Approach Under C-Arm Fluoroscopic Guidance

Foreign bodies in the upper airway and the esophagus are common and often removed in the outpatient setting using the rigid or flexible laryngoscope. Although most esophageal foreign bodies are removed from the digestive tract, in some cases, surgical intervention is required due to its difficult location. Esophageal foreign bodies often removed by esophagogastroduodenoscopy, but when they penetrate the esophagus and move to deep neck spaces, other approaches should be taken into consideration. We report a rare case of a 13-year-old patient whose esophageal foreign body moved to a deep neck compartment, which was embedded in the anterior vertebral muscle. We decided to perform neck exploration under C-arm guidance, successfully targeted and removed the foreign body.

Fish Bone Removal From the Supraglottic Larynx with Flexible Channeled Laryngoscope.

Fish Bone Removal From the Supraglottic Larynx with Flexible Channeled Laryngoscope.