The Value of Dynamic Voice CT Scan for Complex Airway Patients Undergoing Voice Surgery

Abstract

Introduction: Dynamic voice computerized tomography (DVCT) is a novel technique that provides additional information to characterize laryngeal function for patients with complex airway history that may alter surgical decisions. The goal of this study was to evaluate the impact of DVCT on decision making for reconstructive voice surgery for a cohort of post-airway reconstruction dysphonia patients. Methods: Retrospective chart review at a pediatric tertiary care center for patients with history of complex airway surgery and subsequent reconstructive voice surgery for dysphonia between 2010 and 2016. The study group had a DVCT prior to surgery while the control group underwent surgery without a DVCT. Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and pediatric Voice Handicap Index (pVHI) scores were evaluated by the voice clinic team (otolaryngologist, speech therapist) before and after voice surgery. Results: Twenty-one patients were analyzed (14 female, 67%) with a mean age (SD) of 14 (4.5) years old. Ninety percent (17/21) had a prior tracheostomy and a mean (SD) of 2.6 (1.3) airway surgeries. Twelve patients (57%) underwent DVCT prior to reconstructive voice surgery. CAPE-V baseline scores were similar between study and controls (means [SE] = 49 [4.6] and 57 [6.0], P = .72). However, scores significantly improved for the study group after voice surgery (mean [SE] = 31 (4.7), P < .0001) while controls did not improve (58 [5.7], P = .99). Baseline VHI scores were similar between both groups: mean (SE) = 54 (5.4) versus 52 (6.2), respectively, P = .99. Postsurgically, VHI scores were also similar between both groups (means [SE]: 46 [7.1] vs 47 [4.5], P = .99). Reconstructive voice surgery for study patients included posterior cricoid reduction (46%), vocal fold medialization/augmentation (46%), and laryngeal reinnervation (7.7%) while all controls underwent a single treatment (vocal fold medialization/augmentation). Conclusion: Patients with preoperative DVCT were more likely to have improvement. DVCT appeared to have altered surgical decision making and has allowed tailoring of reconstructive surgery to specific patients’ needs. DVCT could represent an important tool prior to reconstructive surgery to guide the choice of surgical procedures for complex airway patients.

Structure and Function of the Vocal Cords after Airway Reconstruction on Magnetic Resonance Imaging

“…The majority of imaging studies of the vocal cords has been done using CT 15,16,25 . The most important downside of CT compared to MRI is exposure to, albeit low, ionizing‐ radiation 16 . Comparison studies between dynamic CT and MRI have never been reported, but our MRI study shows excellent identification of the anatomical structures, and thereby closure defects of the vocal cords, comparable to previous CT studies.…”

“…An important benefit of imaging methods such as CT and MRI is the ability to visualize the vocal cords in a three‐dimensional plane, therefore less influenced by the strongly altered anatomy such as severe supraglottic collapse 15,16,25 . Supraglottic constriction during phonation is a common compensatory mechanism in patients with dysphonia, but can also be a sign of architectural distortion after LTS repair 10,26,27 .…”

“…The majority of imaging studies of the vocal cords has been done using CT 15,16,25 . The most important downside of CT compared to MRI is exposure to, albeit low, ionizing‐ radiation 16 .…”

“…The current gold standard to visualize the vocal cords is videostroboscopy, but downsides are that the images obtained are 2D and nonquantitative and tissue cannot objectively be characterized. Recent advances in computed tomography (CT) and magnetic resonance imaging (MRI) make it possible to noninvasively image structure and function of the pediatric upper airways including the vocal cords 11‐16 . However, no studies have been conducted to see if static and dynamic MR images of the vocal cords correspond to vocal function.…”

Management of A‐Frame Tracheal Deformity in Children With Endoscopic Resection Tracheoplasty

“…Patients with shortness of breath and history of tracheostomy should increase the awareness of the possibly of an A‐frame deformity. As with other sites of airway obstructions, carefully planning is required 11–20 …”