Vocal Quality of Decannulated Children Following Laryngeal Reconstruction

Zalzal, George H.; Loomis, Susan R.; Derkay, Craig S.; Murray, Sharon L.; Thomsen, James H.

doi:10.1288/00005537-199104000-00016

Cited by 18 publications

(13 citation statements)

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“…20 Many studies agree that vocal dysfunction after LTR has major social and functional implications. [2][3][4][5]17,21 To our knowledge, the only published study documenting the impact of LTR on QOL in children with laryngotracheal stenosis was the study published by Zur and Cotton 21 in 2007. This study included a subgroup of children after airway reconstruction revealing that they had elevated scores in the physical and emotional domains in the Pediatric Voice Handicap Index, a validated questionnaire used to evaluate dysphonia in the pediatric population.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5] The data describing voice outcome following LTR are limited. Most studies have heterogeneous groups of patients, with only a few able to provide quantitative data regarding voice outcomes ( Table 6).…”

Section: Voice Outcomesmentioning

confidence: 99%

“…[2][3][4][5][6] However, reports on voice outcome after LTR have been inconsistent due to heterogeneity of patients, insufficient quantitative data, and the use of nonvalidated voice outcome measures. Furthermore, presurgical voice evaluations are not possible in these children due to their young age or the presence of an artificial airway.…”

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confidence: 99%

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Quality of Life and Voice Outcomes after Thyroid Ala Graft Laryngotracheal Reconstruction in Young Children

Tirado

Chadha

Allegro

et al. 2011

Otolaryngol.--head neck surg.

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Section: Discussionmentioning

confidence: 99%

Section: Voice Outcomesmentioning

confidence: 99%

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Quality of Life and Voice Outcomes after Thyroid Ala Graft Laryngotracheal Reconstruction in Young Children

Tirado

Chadha

Allegro

et al. 2011

Otolaryngol.--head neck surg.

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“…Nearly 50% of children who undergo airway reconstruction for subglottic stenosis have a significant risk of developing dysphonia . This impediment may lead to psychosocial problems that affect them over their lifetime .…”

Section: Introductionmentioning

confidence: 99%

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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“…Bei auch während der folgenden Beobachtungszeit weiterhin normaler Atmung, besteht u.E. Demgegnüber ist die Stimme nach LTR häufig hochgradig, bleibend gestört[24,43,49,50]. Desgleichen besteht keine Notwendigkeit für endoskopische "Nachbehandlungen", ein entscheidender Vorteil gegenüber der LTR.…”

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Die Chirurgie der erworbenen laryngotrachealen Stenosen im Kindesalter. Erfahrungen und Ergebnisse von 1988-1998

Vollrath

Freihorst

Hardt

1999

HNO

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Approximately 90% of infants and children with severe acquired laryngotracheal stenoses are tracheotomy dependent and therefore impaired in their physical and speech developments. In addition, tracheotomized infants can be endangered by the cannula due to the possible crusting of secretions or its dislocation. Thus, early repair of a stenosis is mandatory. Within the last 10 years, we successfully operated on 18 children with severe laryngotracheal stenoses. Ten children were treated with a modified Cotton technique. This paper reports our results of cricotracheal resection performed in 8 children since 1994 (age distribution: 7 months through age 15 years). Four children had Cotton grade II stenoses, three had grade III stenoses and one grade IV stenoses. In 3 patients a tracheotomy had been performed at another institution. Since their tracheostomas were too far caudal, they could not be included in the primary resection. All 8 children have been successfully decannulated. Five children without tracheotomies could be extubated uneventfully on the 5th postoperative day. All three primarily tracheotomized children needed further endotracheal stenting with T-tubes because of stomal and suprastomal collapse. Two of these latter children additionally required a tracheoplasty with rib cartilage grafts in order to stabilize the suprastomal trachea prior to decannulation. No patient experienced injuries to the recurrent laryngeal nerves or insufficiencies of the anastomosis. All children's voices were not impaired. This is the third report in literature of cricotracheal resections in infants and children, indicating that this effective, one-stage procedure is superior to laryngotracheal reconstruction with rib cartilage.

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Vocal Quality of Decannulated Children Following Laryngeal Reconstruction

Cited by 18 publications

References 0 publications

Quality of Life and Voice Outcomes after Thyroid Ala Graft Laryngotracheal Reconstruction in Young Children

Quality of Life and Voice Outcomes after Thyroid Ala Graft Laryngotracheal Reconstruction in Young Children

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

Die Chirurgie der erworbenen laryngotrachealen Stenosen im Kindesalter. Erfahrungen und Ergebnisse von 1988-1998

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