Vocal Fold Paralysis In Children Research Articles

Surgical Management of Bilateral Vocal Fold Paralysis in Children: A Systematic Review and Meta-analysis.

To examine and compare the outcomes of various types of glottic widening surgery (GWS) for initial management of bilateral vocal fold paralysis (BVFP) in children, the outcomes of different GWS procedures in children who underwent initial tracheostomy, and the rate of decannulation in children who underwent tracheostomy alone versus tracheostomy followed by GWS. PubMed, Web of Science, Cochrane Library, and Embase were searched following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) on September 9, 2019, with no date restriction. Articles focusing on GWS or tracheostomy for initial management of BVFP were included. Articles describing patients who received no surgical intervention for BVFP were excluded. A total of 5989 articles were reviewed: 67 articles met inclusion criteria, and 240 patients were incorporated into the analysis. Patients who underwent primary GWS had an eventual tracheostomy rate of 6.0% (5/83). There were no statistically significant differences in the rate of tracheostomy, reoperation, or mortality among cricoid split, suture lateralization, and cordectomy/cordotomy. Patients who underwent primary tracheostomy failed to achieve decannulation in 36.9% (58/157) of cases. Decannulation was more likely in tracheostomized children who received GWS than those who did not (odds ratio, 6.336; P < .0001). Most children who undergo primary GWS for BVFP avoid tracheostomy or reoperation. These data demonstrated no differences in surgical outcomes among the most common types of GWS for BVFP. For children who receive a tracheostomy as their first intervention for BVFP, GWS is associated with a significantly improved rate of decannulation.

Bilateral Selective Laryngeal Reinnervation for Bilateral Vocal Fold Paralysis in Children

Bilateral vocal fold paralysis (BVFP) in pediatric patients is a challenging entity with multiple causes. Traditional approaches to managing BVFP include tracheostomy, arytenoidectomy, suture lateralization, cordotomy, and posterior cricoid enlargement. These interventions are used to create a stable airway but risk compromising voice quality. To assess the use of bilateral selective laryngeal reinnervation (SLR) surgery to manage BVFP and restore dynamic function to the larynx in pediatric patients. In this case series performed at 2 tertiary care academic institutions, 8 pediatric patients underwent bilateral SLR to treat BVFP (5 patients with iatrogenic BVFP and 3 with congenital BVFP) from November 2004 to August 2018 with follow-up for at least 1.5 years. Bilateral selective laryngeal reinnervation surgery. Flexible laryngoscopy findings, subjective and objective measures of voice quality, subjective swallowing function, and decannulation in patients who were previously dependent on a tracheostomy tube. Participants included 6 boys and 2 girls with a median age of 9.3 (range, 2.2 to 18.0) years at the time of surgery. All 8 patients were decannulated; 6 patients had preoperative tracheostomies and 2 had perioperative tracheostomies. Voice quality, as measured using the GRBAS (grade, roughness, breathiness, asthenia, strain) scale, improved in 6 of 8 patients after reinnervation, and swallowing was not impaired in any patients. In 2 patients, GRBAS scale scores remained the same before and after surgery. Inspiratory vocal fold abduction was observed on both sides in 5 patients and on 1 side in 2 patients, with no active abduction observed in 1 patient. The follow-up period was more than 5 years in 7 of 8 patients and at least 1.5 years in all patients. Bilateral SLR appears to be a promising treatment option for children with BVFP; it is currently the only option, to our knowledge, with the potential to restore abductor and adductor vocal fold movement. In patients with complete paralysis, this procedure may provide a strategy for airway management and restoration of the dynamic function of the larynx. It could be considered as a first-line technique before endolaryngeal or airway framework procedures, which carry a risk of compromising voice quality.

Clinical evaluation of vocal fold paralysis in 207 children

Objective: To investigate the etiology and clinical characteristics of vocal fold paralysis in children. To provide useful information for diagnosis, management and prognosis in the clinical work. Methods: Two hundred and seven children with vocal fold paralysis in Children's Hospital of Fudan University were retrospectively studied, and followed-up. Results: All the patients had hoarseness.151 cases had vocal paralysis in the left side and the main etiology was pulmonary arterial hypertension.43 cases had bilateral vocal paralysis and all of them had respiratory problems.The main etiology were congenital tracheoesophageal malformations.13 cases had vocal paralysis in the right side.In terms of etiology, 8 cases were related to intracranial lesions, 2 cases were idiopathic. Conclusions: The main etiologies of left vocal fold paralysis were cardiovascular diseases, and bilateral vocal paralysis were congenital tracheoesophageal malformations.The main etiologies of right vocal fold paralysis were neoplastic and central lesion.The prognosis of bilateral vocal fold paralysis and right vocal fold paralysis was poor.

Unilateral Vocal Fold Paralysis in Children: State-of-the-Art Treatment

The goal of this chapter is to present the most up-to-date options in managing unilateral vocal fold paralysis (VFP) in the pediatric population. As this condition affects multiple systems, and options are multiple, it is important to be aware of the potential risks and benefits of each possibility in order to facilitate informed decision making. The use of laryngeal electromyography in the workup of VFP has more recently been popularized as an adjunct in the diagnosis and prognosis for recovery. Moreover, advances in laryngeal reinnervation surgery show promise in the pediatric population. Finally, laryngeal pacing and the use of fibroblast growth factors are important new future directions in the field. Management of unilateral vocal fold paralysis in children can be challenging with many treatment options available. A personalized and tailored approach to each patient is warranted.

Outcomes of Laryngeal Reinnervation for Unilateral Vocal Fold Paralysis in Children: Associations With Age and Time Since Injury.

Outcomes of laryngeal reinnervation with ansa-cervicalis for unilateral vocal fold paralysis (UVFP) may be influenced by age of the patient and time interval between laryngeal nerve injury and reinnervation, suggesting less favorable outcomes in older patients and greater than 2-year time interval after injury. This study examines these issues in the pediatric population. Review of prospectively collected data set of 35 children and adolescents (1-21 years) that underwent ansa-recurrent laryngeal nerve (RLN) laryngeal reinnervation for UVFP. The time from RLN injury to reinnervation averaged 5.0 years (range, 0.8-15.2 years). No correlation was found between age at reinnervation (r = 0.15) and patient- or parent-reported global percentage voice outcome or perceptual ratings. There was slight negative correlation in duration between RLN injury and reinnervation and voice outcomes (r = -0.31). Postoperative voice self/surrogate global percentage rating average was 80.5% (range, 50%-100%), and perceptual rating GRBAS sum score average was 2.9 (range, 0-7). In pediatric ansa-RLN reinnervation for UVFP, no correlation between age at surgery and postoperative outcome was found. Denervation duration showed slight negative correlation, similar to what has been reported in adults, though voice improvement was seen in all patients.

Natural history of vocal fold paralysis in Arnold-Chiari malformation

Abstract Objective : Neurologic disease is the most common cause of bilateral vocal fold paralysis in children. Arnold-Chiari malformations (ACM) account for the majority. Early decompression results in the resolution of preoperative symptoms in the majority of patients. The purpose of present study is to describe the time to vocal fold function recovery following neurosurgical management of children with vocal fold paralysis secondary to ACM. Methods : Prospective case series. Inclusion criteria included diagnoses of both ACM and vocal fold paralysis. All children were followed with office flexible laryngoscopy at two-month intervals following diagnosis until complete return of vocal fold motion was noted. Return of recurrent laryngeal nerve function was confirmed with intraoperative laryngeal electromyography (EMG); one child additionally underwent EMG during partial return of vocal fold function. Results : Four patients met inclusion criteria. Mean age at neurosurgical decompression was 3.1 months (range 1–7.5). Three subjects demonstrated bilateral paralysis; one had a left-sided paralysis. Three subjects, including the child with unilateral paralysis, required tracheotomy. Initial return of vocal fold motion was seen at a mean of 5.75 months after decompression (range 4–8). Complete return of function was seen at a mean of 9.5 months (range 7–12). One child underwent EMG when vocal fold function was initially seen to return, with low-amplitude activity seen. The patient demonstrated full amplitude when EMG was repeated following return of full abduction. EMG likewise confirmed return of motion in the three other subjects. All tracheotomized patients were decannulated without further surgical procedures. Conclusion : Methods of airway management that do not result in permanent alteration of laryngeal anatomy are preferred. Families may be counseled that return of vocal fold function is expected within one year of neurosurgical decompression. The presence of electrical activity on laryngeal EMG may have a role in predicting return of vocal fold motion before complete function is visible on flexible laryngoscopy.

Longevity of micronized alloderm in pediatric augmentation laryngoplasty

Objectives: To report the outcomes of augmentation laryngoplasty using micronized alloderm for the management unilateral vocal fold paralysis in children. Indications for acute management and the observed longevity of micronized alloderm is discussed. Methods: Retrospective chart review of patients with unilateral vocal fold paralysis surgically managed at a tertiay care hospital between July 2002 and December 2003. Results: Eight children with unilateral vocal fold paralysis were identified. Age range at the time of surgical management was 3 weeks to 17 years. Follow-up ranged from 6 months to 14 months. Etiologies included cardiac surgery, idiopathic, and brainstem ependymoma. Five of 8 (62.5%) patients were managed in the acute setting; 4 of 8 (50%) of the augmentation laryngoplasty procedures were performed for significant aspiration, and the other 4 patients were managed for dysphonia. The clinically observed longevity of the micronized alloderm was 3 to 6 months. All patients managed for aspiration had significant objective improvement, and 3/4 (75%) were discharged home feeding orally. Three of 5 (60%) of the children managed in the acute setting had recovery of vocal fold function. No airway complications were observed. Conclusions: Augmentation laryngoplasty using micronized alloderm is a safe option for the acute management of aspiration associated with a unilateral vocal fold paralysis in children. The clinically observed longevity of the collagen in children is 3 to 6 months.

Pediatric bilateral vocal fold immobility: the role of carbon dioxide laser posterior transverse partial cordectomy.

Vocal fold paralysis in children has been estimated to be the second most common congenital abnormality of the pediatric airway. Most commonly, children present with the vocal folds in the midline or adducted position. Pediatric patients usually have a good voice or cry and a poor airway. In these cases, the surgical goal will be improving the airway, usually by lateralizing a vocal fold, while maintaining a normal voice and intact swallowing. The focus of this article is a modification of a technique for use in adults that was introduced by Dennis and Kashima in 1989. The procedure is intended to separate the vocal ligament and vocalis muscle from the arytenoid cartilage with removal of significant tissue mass with the CO2 laser. The demographics and results of 5 pediatric patients who underwent this procedure are discussed. The preoperative goals of airway enlargement, voice preservation, and normal deglutition were achieved in all 5 patients.