Voice outcomes after pediatric airway reconstruction

Alarcón, Alessandro de

doi:10.1002/lary.23814

Cited by 19 publications

(27 citation statements)

References 6 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%

“…16 Voice often becomes more problematic during middle school and high school, many years after airway reconstruction was performed, and experiences of families and patients have influenced the overall management approach. 11 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%

“…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%

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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%

See 2 more Smart Citations

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

et al. 2019

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“…Voice disturbance following airway reconstruction is not uncommon; more than half of children who undergo airway reconstruction are reported to have postoperative dysphonia, which is often described as severe . Historically, the main measure of success for airway reconstruction has been decannulation, but in the past 15 years the importance of postoperative voice quality was realized . Childhood dysphonia is associated with social withdrawal and depression, as well as having negative influence on emotional, educational, and occupational outcomes .…”

Section: Introductionmentioning

confidence: 99%