Predictors of voice outcome in pediatric non‐selective laryngeal reinnervation

Ongkasuwan, Julina; Espinosa, Maria Catalina; Hollas, Sarah; Devore, Danielle; Procter, Teresa; Bassett, Ethan; Schwabe, Aloysia

doi:10.1002/lary.28282

Cited by 13 publications

(14 citation statements)

References 19 publications

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“…Under these circumstances, nerve transfer may be adopted. The ansa cervicalis‐to‐RLN anastomosis could result in improved phonation and nerve reinnervation confirmed by electromyography 7,9,10 . Free nerve grafting using the great auricular nerve can also achieve excellent long‐term postoperative phonatory function 5 …”

Section: Discussionmentioning

confidence: 98%

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A novel method to reconstruct right recurrent laryngeal nerve by transforming into nonrecurrent laryngeal nerve: The end‐to‐free vagal laryngeal branch end anastomosis

Tan

et al. 2021

Head & Neck

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The objective of this study is to demonstrate a novel method for the reconstruction of right recurrent laryngeal nerve (RLN) by transforming into nonrecurrent RLN: the end‐to‐free vagal laryngeal branch end anastomosis. Here we report a case of locally advanced thyroid carcinoma. The patient underwent radical thyroid surgery with inevitably partial RLN resection and immediate right RLN reconstruction at our institution. With the guidance of intraoperative neuromonitoring (IOMN), we completed a novel end‐to‐free vagal laryngeal branch end anastomosis. The whole procedure was deliberately monitored by IOMN. Surgeons can procure adequate free nerve for tension‐free anastomosis by transforming the right RLN into nonrecurrent nerve. Follow‐up laryngoscope showed improved adductory movement of the right arytenoid. The end‐to‐free vagal end anastomosis is an effective way to reconstruct segmental nerve resection of right RLN. Its long‐term postoperative result needs to be further warranted.

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Section: Discussionmentioning

confidence: 98%

“…Due to defect of the nerve function, patients could experience hoarseness, dysphasia, dysphagia, and even dyspnea after surgery. Effective reconstruction of RLN, even after long time of nerve denervation, could annihilate those symptoms and is associated with better quality of life 8–10 …”

Section: Discussionmentioning

confidence: 99%

A novel method to reconstruct right recurrent laryngeal nerve by transforming into nonrecurrent laryngeal nerve: The end‐to‐free vagal laryngeal branch end anastomosis

Tan

et al. 2021

Head & Neck

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“…A recent publication showed that posterior glottic insufficiency was associated with a smaller improvement in PVRQOL (another quality‐of‐life voice survey), suggesting that presence of glottic insufficiency may have a negative impact on outcomes. Out of 32 patients in their cohort, 9 had a suspicion of an intubation injury 40 …”

Section: Discussionmentioning

confidence: 99%

Intubation‐Related Laryngeal Deficiency and Vocal Fold Immobility in Pediatric Premature Patients

2021

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Objectives/Hypothesis We report a posterior laryngeal rating system and measures of voice disability in pediatric patients undergoing phonosurgery for vocal fold paralysis. Posterior glottic deficiency may account for persistent voice disability. Study Design Retrospective Study. Methods Retrospective analyses of 66 subjects with primary unilateral vocal fold paralysis were reviewed for the status of posterior glottis and voice disability (Pediatric Voice Handicap Index [pVHI]). Gestation age (GA), weight, and medical/surgical history were reviewed. The width, length, and depth of the larynx were analyzed to create a reproducible rating scale. Results Mean GA was 29 weeks, with an intubation history for all subjects, with 90% having a left vocal fold immobility. Cardiac surgery was performed in 92% of subjects. A progressive rating (type 0–3) Benjamin Defect Severity Scale (BDSS) was developed to rate the absence or presence of a posterior abnormality. BDSS‐2 and BDSS‐3 subjects were more likely to have low birth weight. Extremely preterm GA was more likely to be associated with BDSS‐1 (mild) or BDSS‐2. History of multiple and prolonged intubations were seen more frequently in BDSS‐2 or BDSS‐3. Post‐op pVHI reduced an average of 15 points for BDSS‐0 to BDSS‐2, but only 3 points for BDSS‐3. Post‐op pVHI matched normal values for preintervention dysphonic children. Conclusions The presence of a persistent breathy voice after intervention for unilateral vocal fold immobility is potentially associated with posterior glottic defects. Low birth weight with multiple/prolonged intubation is more likely to be present with higher‐grade BDs, whereas low GA is more likely to be associated with BDSS‐1 to BDSS‐2. Level of Evidence 4 Laryngoscope, 131:2550–2557, 2021

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“…Having already undergone previous cardiac surgery, patients (and/or their parents) may show resistance to the prospect of further surgery due to additional scarring [24] and so ought to be counselled appropriately on the implications and long-term benefits. Ongkasuwan et al [36] suggests that NSLR procedures should be performed as early as possible to optimise outcomes but also noted that favourable outcomes could still be achieved two decades after the onset of childhood neuronal VCP. They also speculate that preoperative LEMG may have utility in predicting voice outcomes following NSLR but that further data is required [36].…”

Section: Reinnervationmentioning

confidence: 99%

“…Ongkasuwan et al [36] suggests that NSLR procedures should be performed as early as possible to optimise outcomes but also noted that favourable outcomes could still be achieved two decades after the onset of childhood neuronal VCP. They also speculate that preoperative LEMG may have utility in predicting voice outcomes following NSLR but that further data is required [36].…”

Section: Reinnervationmentioning

confidence: 99%

Vocal cord palsy as a sequela of paediatric cardiac surgery – a review

et al. 2021

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Background: Vocal cord palsy is one of the recognised complications of complex cardiac surgery in the paediatric population. While there is an abundance of literature highlighting the presence of this complication, there is a scarcity of research focusing on the pathophysiology, presentation, diagnosis, and treatment options available for children affected by vocal cord palsy. Materials and methods: Electronic searches were conducted using the search terms: “Vocal Cord Palsy,” “VCP,” “Vocal Cord Injury,” “Paediatric Heart Surgery,” “Congenital Heart Surgery,” “Pediatric Heart Surgery,” “Vocal Fold Movement Impairment,” “VFMI,” “Vocal Fold Palsy,” “PDA Ligation.” The inclusion criteria were any articles discussing the outcomes of vocal cord palsy following paediatric cardiac surgery. Results: The two main populations affected by vocal cord palsy are children undergoing aortic arch surgery or those undergoing PDA ligation. There is paucity of prospective follow-up studies; it is therefore difficult to reliably assess the current approaches and the long-term implications of management options. Conclusion: Vocal cord palsy can be a devastating complication following cardiac surgery, which if left untreated, could potentially result in debilitation of quality of life and in severe circumstances could even lead to death. Currently, there is not enough high-quality evidence in the literature to aid recognition, diagnosis, and management leaving clinicians to extrapolate evidence from adult studies to make clinical judgements. Future research with a focus on the paediatric perspective is necessary in providing evidence for good standards of care.

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Predictors of voice outcome in pediatric non‐selective laryngeal reinnervation

Cited by 13 publications

References 19 publications

A novel method to reconstruct right recurrent laryngeal nerve by transforming into nonrecurrent laryngeal nerve: The end‐to‐free vagal laryngeal branch end anastomosis

A novel method to reconstruct right recurrent laryngeal nerve by transforming into nonrecurrent laryngeal nerve: The end‐to‐free vagal laryngeal branch end anastomosis

Intubation‐Related Laryngeal Deficiency and Vocal Fold Immobility in Pediatric Premature Patients

Vocal cord palsy as a sequela of paediatric cardiac surgery – a review

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