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A new solution for neonatal bilateral vocal cord paralysis: Endoscopic arytenoid abduction lateropexy.
Laryngoscope. 2017 07; 127(7):1608-1614.L

Abstract

OBJECTIVES/HYPOTHESIS

Bilateral vocal cord paralysis in early childhood is a life-threatening condition, which often requires immediate intervention. One of the treatment options is a quick, reversible simple suture vocal cord lateralizing technique, whereby the arytenoid cartilage is directly lateralized to the normal abducted position. Considering pediatric laryngeal anatomy, a small endolaryngeal thread guide instrument was designed for precise suture insertion.

STUDY DESIGN

New instrument validation.

METHODS

Four newborns had inspiratory stridor immediately after birth; two had to be intubated. Laryngotracheoscopy revealed bilateral vocal cord paralysis. Unilateral, left-sided endoscopic arytenoid abduction lateropexy was performed with supraglottic jet ventilation on the 4th, 5th, 5th, and 27th day of life for the four patients, respectively.

RESULTS

All babies remained intubated for 3 to 7 days with an uncuffed tracheal tube. After extubation, no dyspnea or swallowing disorder occurred. A subjective quality of life questionnaire, laryngotracheoscopy, clinical growth charts, and voice analysis showed satisfactory functional results.

CONCLUSIONS

Minimally invasive, quick, reversible endoscopic arytenoid abduction lateropexy might be a more favorable solution for neonatal bilateral vocal cord paralysis than earlier treatment strategies. In one step, the airway can be maintained without the risk of any permanent damage to voice production. Good swallowing function is also preserved. The specially modified endolaryngeal thread guide instrument gives a fast and effective option for creating the lateralized arytenoid position even in the technically challenging surgical context of a neonate larynx.

LEVEL OF EVIDENCE

4. Laryngoscope, 127:1608-1614, 2017.

Authors+Show Affiliations

Department of Otorhinolaryngology and Head and Neck Surgery, Stepping Hill Hospital, Stockport National Health Service Foundation Trust, Stockport, United Kingdom.Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary.Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary.Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary.Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary.Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, Szeged, Hungary.Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary.

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

27808413

Citation

Madani, Shahram, et al. "A New Solution for Neonatal Bilateral Vocal Cord Paralysis: Endoscopic Arytenoid Abduction Lateropexy." The Laryngoscope, vol. 127, no. 7, 2017, pp. 1608-1614.
Madani S, Bach Á, Matievics V, et al. A new solution for neonatal bilateral vocal cord paralysis: Endoscopic arytenoid abduction lateropexy. Laryngoscope. 2017;127(7):1608-1614.
Madani, S., Bach, Á., Matievics, V., Erdélyi, E., Sztanó, B., Szegesdi, I., Castellanos, P. F., & Rovó, L. (2017). A new solution for neonatal bilateral vocal cord paralysis: Endoscopic arytenoid abduction lateropexy. The Laryngoscope, 127(7), 1608-1614. https://doi.org/10.1002/lary.26366
Madani S, et al. A New Solution for Neonatal Bilateral Vocal Cord Paralysis: Endoscopic Arytenoid Abduction Lateropexy. Laryngoscope. 2017;127(7):1608-1614. PubMed PMID: 27808413.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A new solution for neonatal bilateral vocal cord paralysis: Endoscopic arytenoid abduction lateropexy. AU - Madani,Shahram, AU - Bach,Ádám, AU - Matievics,Vera, AU - Erdélyi,Eszter, AU - Sztanó,Balázs, AU - Szegesdi,Ilona, AU - Castellanos,Paul F, AU - Rovó,László, Y1 - 2016/11/03/ PY - 2016/09/12/accepted PY - 2016/11/4/pubmed PY - 2017/8/19/medline PY - 2016/11/4/entrez KW - Bilateral vocal fold paralysis KW - dyspnea KW - endolaryngeal thread guide instrument KW - endoscopic arytenoid abduction lateropexy KW - laterofixation KW - neonatal SP - 1608 EP - 1614 JF - The Laryngoscope JO - Laryngoscope VL - 127 IS - 7 N2 - OBJECTIVES/HYPOTHESIS: Bilateral vocal cord paralysis in early childhood is a life-threatening condition, which often requires immediate intervention. One of the treatment options is a quick, reversible simple suture vocal cord lateralizing technique, whereby the arytenoid cartilage is directly lateralized to the normal abducted position. Considering pediatric laryngeal anatomy, a small endolaryngeal thread guide instrument was designed for precise suture insertion. STUDY DESIGN: New instrument validation. METHODS: Four newborns had inspiratory stridor immediately after birth; two had to be intubated. Laryngotracheoscopy revealed bilateral vocal cord paralysis. Unilateral, left-sided endoscopic arytenoid abduction lateropexy was performed with supraglottic jet ventilation on the 4th, 5th, 5th, and 27th day of life for the four patients, respectively. RESULTS: All babies remained intubated for 3 to 7 days with an uncuffed tracheal tube. After extubation, no dyspnea or swallowing disorder occurred. A subjective quality of life questionnaire, laryngotracheoscopy, clinical growth charts, and voice analysis showed satisfactory functional results. CONCLUSIONS: Minimally invasive, quick, reversible endoscopic arytenoid abduction lateropexy might be a more favorable solution for neonatal bilateral vocal cord paralysis than earlier treatment strategies. In one step, the airway can be maintained without the risk of any permanent damage to voice production. Good swallowing function is also preserved. The specially modified endolaryngeal thread guide instrument gives a fast and effective option for creating the lateralized arytenoid position even in the technically challenging surgical context of a neonate larynx. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:1608-1614, 2017. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/27808413/A_new_solution_for_neonatal_bilateral_vocal_cord_paralysis:_Endoscopic_arytenoid_abduction_lateropexy_ DB - PRIME DP - Unbound Medicine ER -