Endoscopic posterior costal cartilage graft placement for acute management of pediatric bilateral vocal fold paralysis without tracheostomy

Department of Otolaryngology, University of Illinois at Chicago, Chicago, USA.
International Journal of Pediatric Otorhinolaryngology (Impact Factor: 1.32). 11/2008; 72(10):1555-8. DOI: 10.1016/j.ijporl.2008.06.015
Source: PubMed

ABSTRACT Endoscopic posterior cricoid split with costal cartilage graft stabilization has previously been shont to allow for glottic/infraglottic expansion in children with long standing vocal fold paralysis. We report on an extension of this technique to use in the acute setting in the management of acute BVP in children with acute upper airway obstructive symptoms.

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    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.
    International Journal of Pediatric Otorhinolaryngology Extra 12/2011; DOI:10.1016/j.pedex.2010.11.008
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    ABSTRACT: Objectives To review a multi-institutional experience using endoscopic posterior cricoid split and costal cartilage graft (EPCSCG) placement in the management of pediatric bilateral vocal fold immobility (BVFI), posterior glottic stenosis (PGS), and subglottic stenosis (SGS).DesignCase series with chart review.SettingTertiary medical centers.Methods Review of all patients treated between 2004 and 2012 with EPCSCG placement in 3 academic and multispecialty group settings. The main outcomes measured include indications, complications, and outcome (need for additional procedures, decannulation rate).ResultsA total of 28 patients underwent EPCSCG. Age range at time of surgery was 1 month to 15 years (mean, 56 months). Overall, 25 of 28 were decannulated or never required tracheostomy, and 24 of 28 had adequate symptom control with mean follow-up of 25 months. Twenty-two patients had resolution of their symptoms without additional procedures. Sixteen patients had SGS in isolation or in combination with cricoarytenoid fixation, glottic stenosis, or vocal fold immobility. Decannulation and/or symptom control was achieved in 14 of 16. Three patients had isolated PGS or cricoarytenoid fixation with all achieving decannulation. Nine patients had isolated BVFI with 7 being able to achieve resolution of their airway symptoms, 5 without additional procedures.Conclusion This descriptive series shows a consistent outcome in more than double the number of cases previously reported in the previously published series. We believe that EPCSCG is an important option to have in the management of pediatric glottis/subglottic stenosis and bilateral vocal fold immobility.
    Otolaryngology Head and Neck Surgery 01/2013; 148(3). DOI:10.1177/0194599812472435 · 1.72 Impact Factor
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    ABSTRACT: To confirm and extend reported successful treatment of posterior glottic stenosis in pediatric patients using endoscopic laser division of the posterior cricoid plate with augmentation using costal cartilage. A retrospective chart review and case series. Medical records were examined to determine the surgical indications, outcomes, and postoperative complications of this procedure. Twelve patients underwent the procedure, six females and six males, with an average age of 7 years (range, 2-26 years). There were 8/12 (67%) patients successfully decannulated after being tracheostomy dependent. There were no consistent anatomic abnormalities or surgical findings predictive of failure to decannulate. Average hospital stay was 3.6 days (range, 2-9 days). There were no deaths or other major complications; one patient had extrusion. Endoscopic posterior cricoid grafting is a valuable surgical option for patients with posterior glottic stenosis. The procedure is associated with low morbidity and permits decannulation in the majority of patients.
    The Laryngoscope 05/2011; 121(5):1062-6. DOI:10.1002/lary.21579 · 2.03 Impact Factor