Bilateral vocal fold Paralysis in infants: tracheostomy or not?

Abstract

Tracheostomy has, in the past, been performed in the majority of children under one year with bilateral vocal fold paralysis. We present our experience of 11 cases over a ten-year period during which tracheostomy was avoided whenever possible. Ten cases were managed conservatively but in the youngest a tracheostomy was required. Full bilateral vocal fold mobility developed in all cases at a mean age of 11.5 months (range 5–26 months). Our experience suggests that the airway can commonly be managed expectantly without a tracheostomy.

Paralisia de prega vocal em crianças: diagnóstico e conduta a partir de relato de caso

“…It may be explained by the fact that left recurrent laryngeal nerve presents a longer path 4 , and it may be related with ductus arteriosus 2 , making it susceptible to damage during the progression of many diseases and surgical procedures. Male patients are more frequently affected as reported in many studies 2,3,5,6 . The main signal of vocal fold paralysis in childhood, both unilateral and bilateral, is stridor, and laryngeal paralysis is the second most common cause of stridor in this age range 2 , second only to laryngomalacia.…”

“…Bilateral paralysis is normally present with cyanosis and apnea 3,4 , whereas unilateral cases are presented with dysphonia and crying affections 1,4,7 . Considering bilateral paralysis, the main causes are neurological, idiopathic and birth trauma [1][2][3][4][5][6] . Among neurological causes, Arnold-Chiari malformation, associated with meningomyocele and hydrocephalus, is the most common one and it is normally manifested at about the 3rd month of life [1][2][3][4] .…”

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

“…Eighteen articles reported adult or mixed adult and pediatric population without a separate analysis [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66]. 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]…”

“…Adult population, not relevant 57 Hagan [53] Adult population 58 Ishman et al [52] Irrelevant, Studying the difference in the management of pediatric and adult population 59 Ahmad et al [64] Adult population 60 Clerf [54] Adult population, discussing surgical treatment 61 Dworkin and Treadway [55] Adult population 62 Fox [56] Adult population 63 Gorman and Woodward [57] Mixed adult and pediatric population without separate analysis 64 Hirose [66] Mixed adult and pediatric population without separate analysis 65 Kearsley [58] Adult population 66 King [59] Adult population, case reports 67 Pinto et al [60] Adult population 68 Renfrew [61] Adult population 69 Rinne [62] Adult population 70 Rosenthal et al [65] Adult population 71 Sellars [63] Adult population, studying the efficacy of surgical procedure 72 Chmielik et al [100] No enough information about the patients, no information about recovery 73 Cohen et al [101] No information about recovery 74 Daya et al [3] No information about recovery 75 Fearon and Ellis [102] No information about recovery 76 Holinger et al [103] No information about recovery 77 Holinger et al …”

“…El-Hakim [8] Does not fit the selection criteria (F/U length not mentioned, recovery assessment not clear, and patients sample contaminated by Botox use) 100 Maturo et al [72] Does not fit the selection criteria (sample included patient who underwent LEMG only, length of recovery not mentioned 101 Hasniah et al [73] Does not fit the selection criteria (sampling method not clear, F/U length not mentioned, diagnostic method and definition of BCILP not clear) 102 Murty et al [74] Does not fit the selection criteria (Sampling is not clear, some patients diagnosed after 3 months of age, diagnostic method and definition of BCILP not clear) 103 Zbar and Smith [6] Definition of disease is not certain. Fixation can not be ruled out as the endoscopy method used for diagnosis is not specified 104 Cohen et al [75] Sampling issue.…”