Surgical Management of Posterior Glottic Diastasis in Children

Sidell, Douglas; Zacharias, Stephanie; Balakrishnan, Karthik; Rutter, Michael J.; Alarcón, Alessandro de

doi:10.1177/0003489414543100

Cited by 20 publications

(21 citation statements)

References 10 publications

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“…Given that parents have distinct recollections of time spent in the hospital following reconstruction and worry about injury to a well reconstructed airway, patients and parents are often at odds as to whether to pursue additional surgery. These contrasting viewpoints have impeded progress in the development of operations designed to improve voice …”

Section: Introductionmentioning

confidence: 99%

“…Over the last decade, significant experience has been gained in the management of children and young adults with postoperative and postintubation dysphonia, which is often caused by posterior glottic diastasis. [9][10][11] Many of these children and young adults use an alternative compensatory laryngeal structure as the primary sound source for voicing (e.g., supraglottal sources such as the false vocal folds, aryepiglottic folds, arytenoids, and epiglottic petiole). 12,13 These vibratory sources frequently produce acoustic signals that are aperiodic or quasiperiodic and are characterized as type 2 or type 3 signals.…”

Section: Introductionmentioning

confidence: 99%

“…These contrasting viewpoints have impeded progress in the development of operations designed to improve voice. [9][10][11] Prior work in the treatment of posterior glottic diastasis established an open procedure for the management of the dysphonia-posterior cricoid reduction. 9 In view of the reluctance of parents to revisit their child's hospital experience and undergo another lengthy open procedure, adaptations were made to create an endoscopic procedure that would address both the dysphonia and parental concernsendoscopic posterior cricoid reduction (EPCR).…”

Section: Introductionmentioning

confidence: 99%

“…9 In view of the reluctance of parents to revisit their child's hospital experience and undergo another lengthy open procedure, adaptations were made to create an endoscopic procedure that would address both the dysphonia and parental concernsendoscopic posterior cricoid reduction (EPCR). 10,17 With the above-cited information in mind, the aims of the present study were to describe the preoperative evaluation of patients who are candidates for EPCR as well as their perioperative and postoperative outcomes. We also sought to validate the aerodynamic benefit of EPCR using computation fluid dynamics (CFD)-based modeling from computed tomography (CT) scans.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic posterior cricoid reduction: A surgical method to improve posterior glottic diastasis

et al. 2019

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Objectives/Hypothesis Describe the preoperative evaluation of patients with glottic diastasis who are candidates for endoscopic posterior cricoid reduction (EPCR) and their perioperative and postoperative surgical and voice outcomes, and validate the aerodynamic benefit of EPCR using computation fluid dynamics (CFD)‐based modeling from computed tomography (CT) scans. Study Design Retrospective case series. Methods Thirteen patients who underwent EPCR were followed from 2013 to 2017. They received a preoperative voice evaluation, microlaryngoscopy and bronchoscopy, dynamic voice CT (performed on patients seen from 2014 to study completion), and postoperative voice evaluation (n = 12). Postoperative inpatient days, complications, and postoperative endoscopic intervention were collected. To validate the aerodynamic benefit of EPCR, CFD modeling was carried out on one patient. Results Thirteen patients (nine females, nine with intubation injury, and four with post–airway reconstruction dysphonia) underwent EPCR at a mean age of 11.0 years. The mean preoperative and postoperative Pediatric Voice handicap Index scores were 53.8 and 33.8, respectively (P = .006). Mean maximum phonation time preoperatively and postoperatively was 5.3 and 6.7, respectively (P = .04). Of eight patients who underwent preoperative CT imaging, all demonstrated a posterior gap. Modeling demonstrated a change in flow and pressure. The mean hospital stay was 2.4 days. Nine patients underwent postoperative endoscopic intervention, and one experienced a complication that resolved with intervention. Conclusions Patients who underwent EPCR for dysphonia following intubation or airway reconstruction showed improvements in vocal efficiency, loudness, and perceived voice handicapping. Their hospital stay was brief, with few complications. CFD modeling corroborated these clinical findings. EPCR thus warrants consideration in the management of patients with posterior glottic diastasis. Level of Evidence 4 Laryngoscope, 129:S1–S9, 2019

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endoscopic posterior cricoid reduction: A surgical method to improve posterior glottic diastasis

et al. 2019

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“…Correspondingly, the American Residency Review Committee for Surgery and the American Surgical Association recommend simulation training. 13,14 We describe a modification to an aforementioned dissection station 15 that can be used to simulate endoscopic cricoid reduction and expansion. No other endoscopic simulations are available for pediatric cricoid grafting.…”

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confidence: 99%

Simulation of Pediatric Endoscopic Cricoid Reduction and Expansion

et al. 2020

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Endoscopic cricoid expansion and reduction are newer approaches to the management of pediatric bilateral vocal fold immobility and postlaryngotracheal reconstruction glottic insufficiency, respectively. These procedures offer a less invasive, endoscopic alternative to procedures that typically required open management with a more prolonged recovery. These technically demanding procedures are currently performed only in select centers, and there is no currently described training model for practicing them. We present a modification to a laryngeal dissection station that allows for simulation of endoscopic cricoid reduction and expansion with excised larynges. The model allows trainees to practice endoscopic posterior cricoid exposure, incision of the cricoid cartilage, placement of a simulated costal cartilage graft for expansion, and endoscopic suturing for reduction. Development of simulators for procedures that are infrequently performed have the potential to help trainees reach surgical competency faster and more safely.

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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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Surgical Management of Posterior Glottic Diastasis in Children

Cited by 20 publications

References 10 publications

Endoscopic posterior cricoid reduction: A surgical method to improve posterior glottic diastasis

Endoscopic posterior cricoid reduction: A surgical method to improve posterior glottic diastasis

Simulation of Pediatric Endoscopic Cricoid Reduction and Expansion

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

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