Laser arytenoidectomy in children with bilateral vocal fold immobility

Abstract

Bilateral vocal fold immobility in children is a challenging problem because a balance between good airway and voice quality has to be achieved. Surgery to improve the airway is often postponed or avoided because of fear of losing the voice. In this study our results of laser arytenoidectomy in children are described. This was a retrospective case notes review at a tertiary level paediatric ENT department. The six patients in this case series ranged from nine to 16 years old at the time of laser arytenoidectomy. Post-operative airway and voice quality were assessed. All children in the series had an adequate post-operative airway. Four of these patients had tracheostomies pre-operatively and achieved decannulation. All six patients rated their post-operative voice as better than pre-operatively. This is principally due to increased loudness associated with increased airflow through the larynx, particularly after tracheostomy decannulation. It is recommended that special care should be taken not to disturb the anterior two thirds of the vocal fold during the surgery in order to achieve a good post-operative voice outcome.

Laser arytenoidectomy in the management of bilateral vocal cord paralysis in children

“…The present study showed that the CO 2 laser arytenoidectomy resulted in good post-operative outcomes in respiratory function for 13 patients (76.5%). 78.5% of tracheotomy/ intubation-dependent patients achieved decannulation/extubation compared with 66% for Worley et al [27]. Among the 11 decannulated/extubated patients, bilateral VCP was the only significant pathology in 4 and associated with concomitant conditions in 7; furthermore, arytenoidectomy was the first surgery for five and followed laryngo-tracheal surgery in six.…”

Upper Airway Obstruction in Children

“…As spontaneous recovery rates of up to 70 % are reported, an interval of at least a year is often given before an airway widening procedure is undertaken [31]. CO 2 laser is the treatment modality of choice [33].…”

Spontaneous recovery of bilateral congenital idiopathic laryngeal paralysis: Systematic non-meta-analytical review

“…Sixteen articles had flaws that disqualified them from inclusion (sampling, diagnostic definition, incomplete follow up, and non-objective assessment of final outcome) [2,4,[6][7][8]14,[67][68][69][70][71][72][73][74][75][76]. Twenty-one articles were assessing glottic expansion procedures on highly selected groups [9,[77][78][79][80][81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96]. Three articles were studying a certain diagnostic modality [97][98][99].…”

“…Plouin-Gaudon et al [90] Studying the efficacy of a specific surgical technique 16 Priest et al [91] Studying the efficacy of a specific surgical technique, case reports 17 Rethi [92] Studying the efficacy of a specific surgical technique 18 Triglia et al [93] Studying the efficacy of a specific surgical technique 19 Worley et al [94] Studying the efficacy of a specific surgical technique 20…”