Injection Medialization Laryngoplasty in Children

Cohen, Michael S.; Mehta, Deepak; Maguire, Raymond C.; Simons, Jeffrey P.

doi:10.1001/archoto.2011.24

Cited by 42 publications

(13 citation statements)

References 15 publications

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“…Importantly, many of the studies done on this subject focus on the impact of dysphonia rather than dysphagia associated with UVFI. Swallowing dysfunction should not be overlooked, however, because reflux disease, feeding difficulties, and choking are commonly exhibited symptoms in affected children .…”

Section: Discussionmentioning

confidence: 99%

“…Of these options, IL is the only one indicated for potentially reversible UVFI because the procedure can be performed with a temporary injectate that reabsorbs over time. IL has historically been performed less often in children than in adults, in part because of concerns regarding the potential for airway obstruction due to the smaller size of the pediatric larynx . In recent years, there has been an increasing interest in IL to improve symptoms of aspiration with feeding, facilitate return to a normal diet, and potentially obviate the need for a gastrostomy tube (G‐tube).…”

Section: Introductionmentioning

confidence: 99%

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Safety and efficacy of Early injection laryngoplasty in pediatric patients

Bertelsen¹,

Jacobson²,

Osterbauer

et al. 2018

The Laryngoscope

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Objective: The major morbidity of unilateral vocal fold immobility (UVFI) in children is due to aspiration. Early injection laryngoplasty (IL) can decrease aspiration risk; however, this has not been well studied in pediatric otolaryngology. This study examines safety and efficacy of early IL in children.Methods: Retrospective review of pediatric patients undergoing IL with any injectate between 2006 and 2017 within 6 months of onset of UVFI. Outcomes included diet pre-and postprocedure, incidence of aspiration-related sequelae, and adverse events.Results: Seventeen patients met eligibility criteria. Ten (58.8%) were males. Median age was 8 months (interquartile range, 2 months-11.5 years). All patients had prior surgeries; the largest subgroup (11 patients, 64.7%) had UVFI after repair of a congenital cardiac defect. Other causes included thyroidectomy, high vagal injury, and prolonged intubation. Sixteen patients underwent swallowing evaluation prior to IL and 14 patients required dietary modifications due to aspiration risk. Consistency and/or volume of oral intake improved after IL in 10 (71.4%) of them. Five patients underwent gastrostomy tube placement for significant oromotor incoordination. Children with congenital cardiac defects had more previous surgeries (3.0 ± 0.4 vs. 1.2 ± 0.2, P = .006) and were more likely to require G-tube placement due to poor feeding despite IL (45% vs. 0%, P = .05). No patients experienced adverse events due to IL; in particular, none experienced airway symptoms requiring intubation.Conclusion: Early IL in pediatric patients with UVFI is safe and can reduce aspiration and improve oral intake. Future studies should elucidate patient subgroups most likely to benefit from this intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of Early injection laryngoplasty in pediatric patients

Bertelsen¹,

Jacobson²,

Osterbauer

et al. 2018

The Laryngoscope

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“…Identifying the presence of vocal cord dysfunction is the first step in directing subsequent therapy, including surgical intervention as medialization of the affected vocal cord has been shown to reduce the rate of pneumonia and length of stay. 20,21 …”

Section: Discussionmentioning

confidence: 99%

Vocal Cord Paralysis and Dysphagia after Aortic Arch Reconstruction and Norwood Procedure

Pham

Connelly²,

Wei

et al. 2014

Otolaryngol.--head neck surg.

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Objectives Determine the incidence of vocal cord paralysis and dysphagia after aortic arch reconstruction including Norwood procedure. Setting Tertiary Children’s Hospital Study Design Retrospective cohort. Methods Database/chart review of neonates requiring Norwood or arch surgery between January 2005 through December 2012. Demographics, postoperative vocal cord function, dysphagia, need for gastrostomy tube and/or tracheotomy, and long-term follow-up were reviewed. Results One hundred fifty-one consecutive subjects(96 Norwood, 55 aortic arch) were reviewed. Median age at repair was 9 days(IQR 7–13) for Norwood, 24 days(IQR 12–49) for arch reconstruction(p<0.001). Documentation of VC motion abnormality was found in 60/104(57.6%) subjects, and unavailable in 47:16 without documentation and 31 who expired prior to extubation. There were no significant differences in proportions of documented VC motion(p=0.337), dysphagia(p=0.987), and VC paralysis(p=0.706) between the arch and Norwood groups. Dysphagia was found in 73.5% of Norwood and 69.2% of arch subjects who had documented VC paralysis. Even without UVCP, dysphagia was present (56% Norwood,61% arch). Overall, 120/151(79.5%) required feeding evaluation and modified feeding regimen. Gastrostomy was required in 31% of Norwood and 23.6% of arch reconstruction overall. To date, mortality in this series is 55/151(36.4%) patients. Of those with VC paralysis, only 23(22%) had any otolaryngology follow-up after discharge from surgery. Over 75% with VC paralysis with follow-up after hospital discharge had persistent VC paralysis 11.5 months after diagnosis. Conclusion There is high incidence of UVCP and dysphagia after Norwood and arch reconstruction. Dysphagia was highly prevalent in both groups even without UVCP. Preoperative discussion on vocal cord function and dysphagia should be considered.

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“…Totally 50 reported were collected, including 19 (38%) case reports or case series [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29], 1 (2%) technique [30], 17 (34%) retrospective [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48] and 13 (26%) prospective reports [7,11,[49][50][51][52][53][54][55][56][57][58][59].…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-six percent of the patients required surgical intervention, including injection into the paralyzed fold and medialization thyroplasty [4]. Gelfoam, radiesse voice, and radiesse voice gel injections in patients with hoarseness led to improvement in 94% [48]. Joo et al [47] reported that injection laryngoplasty or medialization thyroplasty were applied in all three of their patients with permanent vocal cord paralysis.…”

Section: Managementmentioning

confidence: 99%

Hoarseness subsequent to cardiovascular surgery, intervention, maneuver and endotracheal intubation: The so-called iatrogenic Ortner’s (cardiovocal) syndrome

Yuan¹

2012

Cardiol J

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Injection Medialization Laryngoplasty in Children

Abstract: This study supports injection laryngoplasty as a safe and effective intervention for children with glottic insufficiency. Further prospective studies are necessary to confirm these findings.

Cited by 42 publications

References 15 publications

Safety and efficacy of Early injection laryngoplasty in pediatric patients

Safety and efficacy of Early injection laryngoplasty in pediatric patients

Vocal Cord Paralysis and Dysphagia after Aortic Arch Reconstruction and Norwood Procedure

Hoarseness subsequent to cardiovascular surgery, intervention, maneuver and endotracheal intubation: The so-called iatrogenic Ortner’s (cardiovocal) syndrome

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Injection Medialization Laryngoplasty in Children

Abstract: This study supports injection laryngoplasty as a safe and effective intervention for children with glottic insufficiency. Further prospective studies are necessary to confirm these findings.

Cited by 42 publications

References 15 publications

Safety and efficacy of Early injection laryngoplasty in pediatric patients

Safety and efficacy of Early injection laryngoplasty in pediatric patients

Vocal Cord Paralysis and Dysphagia after Aortic Arch Reconstruction and Norwood Procedure

Hoarseness subsequent to cardiovascular surgery, intervention, maneuver and endotracheal intubation: The so-called iatrogenic Ortner&#8217;s (cardiovocal) syndrome

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Product

Resources

About

Hoarseness subsequent to cardiovascular surgery, intervention, maneuver and endotracheal intubation: The so-called iatrogenic Ortner’s (cardiovocal) syndrome