Surgical Management of Bilateral Vocal Fold Paralysis in Children: A Systematic Review and Meta‐analysis

Abstract

Objectives To examine and compare the outcomes of various types of glottic widening surgery (GWS) for initial management of bilateral vocal fold paralysis (BVFP) in children, the outcomes of different GWS procedures in children who underwent initial tracheostomy, and the rate of decannulation in children who underwent tracheostomy alone versus tracheostomy followed by GWS. Data Sources PubMed, Web of Science, Cochrane Library, and Embase were searched following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) on September 9, 2019, with no date restriction. Review Methods Articles focusing on GWS or tracheostomy for initial management of BVFP were included. Articles describing patients who received no surgical intervention for BVFP were excluded. Results A total of 5989 articles were reviewed: 67 articles met inclusion criteria, and 240 patients were incorporated into the analysis. Patients who underwent primary GWS had an eventual tracheostomy rate of 6.0% (5/83). There were no statistically significant differences in the rate of tracheostomy, reoperation, or mortality among cricoid split, suture lateralization, and cordectomy/cordotomy. Patients who underwent primary tracheostomy failed to achieve decannulation in 36.9% (58/157) of cases. Decannulation was more likely in tracheostomized children who received GWS than those who did not (odds ratio, 6.336; P < .0001). Conclusions Most children who undergo primary GWS for BVFP avoid tracheostomy or reoperation. These data demonstrated no differences in surgical outcomes among the most common types of GWS for BVFP. For children who receive a tracheostomy as their first intervention for BVFP, GWS is associated with a significantly improved rate of decannulation.

Polyhydramnios associated with congenital bilateral vocal cord paralysis: A case report

“…The natural history of BVCP depends on its etiology, including trauma, neurologic disorders (e.g., Arnold–Chiari malformation, hydrocephalus, and cerebral palsy), hypoxia, as well as iatrogenic (e.g., related to intubation or surgery) and idiopathic causes. [ 24 ]…”

“…The natural history of BVCP depends on its etiology, including trauma, neurologic disorders (e.g., Arnold-Chiari malformation, hydrocephalus, and cerebral palsy), hypoxia, as well as iatrogenic (e.g., related to intubation or surgery) and idiopathic causes. [24] A retrospective review of idiopathic BVCP cases showed that of the 26 neonates, 19 (73%) underwent endotracheal intubation immediately after birth. Among them, 14 (74%) could not be extubated; therefore, they underwent tracheostomy at a median age of 62 days.…”

Surgery for bilateral vocal fold paralysis: Systematic review and meta-analysis

“…A meta-analysis by Thorpe and Kanotra examined only paediatric patients (115). They compared the decannulation rates of four different surgical techniques (suture lateralization, cricoid split, arytenoidectomy and cordectomy/ cordotomy).…”

Characterizing Pediatric Bilateral Vocal Fold Dysfunction: Analysis with the Pediatric Health Information System Database

“…Pediatric bilateral vocal fold dysfunction (BVFD) is a well-documented cause of neonatal respiratory distress and stridor and is typically defined as immobility or hypomobility involving both true vocal folds. 1,2 Among all causes of neonatal stridor, vocal fold dysfunction is the second most common (6%-23%) after laryngomalacia (45%-75%) with reports of bilateral involvement ranging from 30% to 60%. [2][3][4][5] The reported annual incidence of pediatric congenital BVFD is approximately 0.75 per 1,000,000 neonates cases.…”

“…2,6 The natural course is influenced by the etiology of BVFD with the most common being congenital idiopathic (58.5%), neuromuscular (27.2%), and iatrogenic (14.2%) based on a recent systematic review. 1 The reported spontaneous recovery rate is highly variable but in general, has been reported between 50% and 65% of patients with BVFD with studies reporting differences in recovery depending on etiology; in general, those with idiopathic BVFD were more likely to spontaneously improve. 2,[7][8][9] The historical gold standard treatment has been early tracheostomy (performed in 57%-100% of cases), although there appears to be a trend favoring conservative surgical management first with glottic widening surgery (cricoid split, arytenoidectomy, suture lateralization, cordectomy, botox) given the psychological, financial, and social disadvantages involved in the management of a tracheostomy.…”