Vocal fold medialization in children: Injection laryngoplasty, thyroplasty, or nerve reinnervation?
ABSTRACT To review surgical interventions for pediatric unilateral vocal fold immobility (UVFI).
Retrospective medical chart review.
Two tertiary academic centers.
All children who underwent vocal fold medialization for dysphonia, with or without aspiration, from January 2004 to September 2006.
Injection laryngoplasty, ansa cervicalis-recurrent laryngeal nerve anastomosis, or thyroplasty.
Age, sex, intervention, etiology, time from onset of UVFI to surgery, subjective success in improving voice, subjective duration of improvement, and complications.
Twenty-seven procedures were performed in 15 patients (mean age, 10.6 years). Nineteen injection laryngoplasties, 3 thyroplasties (1 bilateral), 2 ansa cervicalis-recurrent laryngeal nerve reinnervation procedures, 1 adduction arytenoidopexy, and 1 cricothyroid joint subluxation were performed. Causes of UVFI included thoracic surgery in 6 cases (40%), prolonged intubation in 4 (26%), central nervous system neoplasm in 3 (20%), unknown etiology in 1 (7%), and anoxic brain injury in 1 (7%). The mean duration from onset of symptoms to treatment was 47 months. There was 1 surgical complication (postoperative aspiration pneumonia following thyroplasty while the patient was under local anesthesia). Parents reported a satisfactory outcome in all cases.
Injection laryngoplasty, thyroplasty, and nerve reinnervation can be performed in pediatric patients with good outcomes and an acceptable safety profile. This article describes the experiences of 2 institutions with phonosurgery for UVFI in children and provides insight into the advantages and disadvantages of each procedure. Prospective studies, with validated quality-of-life measurements, are needed to greater clarify the role of different types of phonosurgery in children with UVFI.
- [Show abstract] [Hide abstract]
ABSTRACT: In this paper, we have proposed an image processing system for the acquisition and processing of three-dimensional images based on confocal scanning laser microscopy for the purpose of three-dimensional visualization and quantitative analysis of cell nuclei. The three-dimensional visualization methods can be divided into surface rendering and volume rendering. The way that surface rendering is used within this system is based on contour modeling. This method consists of several steps as follows. The first step is to preprocess the volume data obtained. Secondly, the extraction of the contours of each slice is carried out. Thirdly, smoothing algorithms are used to refine the contour data and remove wiggles. Since the surface rendering accounts only for the surface, the inside is not visible. Therefore, based on the basic volume rendering pipeline, we implemented the volume rendering. In the quantification step, in order to extract quantitative features, we made a three-dimensional labeling method based on slice information. Compared to the conventional algorithms, this method has advantages due to the use of memory is highly efficient and it is possible to combine a variety of two-dimensional labeling algorithms to find an appropriate labeling to its application. After applying the labeling algorithm, we extracted the measurements for the three-dimensional quantitative analysis of cell nuclei: nuclear volume, surface area and spherical shape factor. This could become a way to improve the accuracy and reproducibility of quantifying cell nuclei. We believe that our method will become a useful diagnostic tool for the medical image analysis.Enterprise Networking and Computing in Healthcare Industry, 2004. HEALTHCOM 2004. Proceedings. 6th International Workshop on; 07/2004
- [Show abstract] [Hide abstract]
ABSTRACT: The primary objective of this study was to determine whether a simplified technique for intraoperative laryngeal electromyography was feasible using standard nerve integrity monitoring electrodes and audiovisual digital recording equipment. Our secondary objective was to determine if laryngeal electromyography data provided any additional information that significantly influenced patient management. Between February 2006 and February 2007, 10 children referred to our institution with vocal fold immobility underwent intraoperative laryngeal electromyography of the thyroarytenoid muscles. A retrospective chart review of these 10 patients was performed after institutional review board approval. Standard nerve integrity monitoring electrodes can be used to perform intraoperative laryngeal electromyography of the thyroarytenoid muscles in children. In 5 of 10 cases reviewed, data from laryngeal electromyography recordings meaningfully influenced the care of children with vocal fold immobility and affected clinical decision-making, sometimes altering management strategies. In the remaining 5 children, data supported clinical impressions but did not alter treatment plans. Two children with idiopathic bilateral vocal fold paralysis initially presented with a lack of electrical activity on one or both sides but went on to develop motor unit action potentials that preceded recovery of motion in both vocal folds. Our findings suggest that standard nerve monitoring equipment can be used to perform intraoperative laryngeal electromyography and that electromyographic data can assist clinicians in the management of complex patients. Additionally, there may be a role for the use of serial intraoperative measurements in predicting recovery from vocal fold paralysis in the pediatric age group.International Journal of Pediatric Otorhinolaryngology 02/2008; 72(1):31-40. DOI:10.1016/j.ijporl.2007.09.011 · 1.19 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: To assess the outcomes of management of unilateral vocal fold paralysis by ansa-RLN reinnervation in a series of patients ages 12-21. Clinical outcomes study. Six consecutive adolescents and young adults (ages 12-21 years) seeking treatment for unilateral vocal fold paralysis and glottal incompetence underwent ansa-RLN neurorraphy. Pre- and post-operative voice recordings acquired at least 1 year following surgery were submitted to acoustic and perceptual analysis. Patient-based measures were also taken. Mean perceptual visual analogue scale rating of dysphonia severity (0mm=profoundly abnormal voice, 100mm=completely normal voice) improved from 50mm pre-operatively to 82mm post-operatively. Mean maximum phonation time improved from 6.5s to 13.2s. Pitch and dynamic range were also observed to improve. Global self-ratings of voice function (0-100%) increased from 31.2% to 81.6% of normal. Ansa-RLN reinnervation is an effective treatment option for adolescents and young adults with unilateral vocal fold paralysis. The procedure has the potential to improve vocal function substantially, especially in those with isolated paralysis of the recurrent laryngeal nerve. The procedure alleviates the disadvantages associated with other surgical options for this age group.International Journal of Pediatric Otorhinolaryngology 07/2008; 72(9):1311-6. DOI:10.1016/j.ijporl.2008.05.004 · 1.19 Impact Factor