Miyamoto R Christopher, Parikh Sanjay R, Gellad Walid, Licameli Greg R
Department of Otolaryngology and Communication Disorders, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA.
Otolaryngol Head Neck Surg. 2005 Aug;133(2):241-5. doi: 10.1016/j.otohns.2005.02.019.
To review the management and outcome of bilateral congenital true vocal cord paralysis in 22 patients treated over a 16-year period and to review the role of tracheostomy in these patients.
Retrospective chart review.
Pediatric tertiary hospital.
Twenty-two pediatric patients diagnosed with bilateral congenital true vocal cord paralysis.
Flexible or rigid diagnostic evaluation, tracheostomy, and vocal cord lateralization procedures.
Vocal cord recovery and decannulation.
With a mean follow up of 50 months, 15 of 22 patients (68%) with bilateral vocal cord paralysis required tracheostomy for airway securement. Of the 15 tracheotomized patients, 10 were successfully decannulated (8 had spontaneous recovery, whereas 2 required lateralization procedures). Eleven of these patients with tracheostomy had comorbid factors, including neurologic abnormalities (midbrain/brainstem dysgenesis, Arnold-Chiari malformation, global hypotonia, and developmental delay). Of the 7 patients not requiring tracheostomy, 6 recovered vocal cord function (86%).
In our series of 22 patients with bilateral vocal cord paralysis, 14 had spontaneous recovery of function. Patients managed with tracheostomy were noted to have a high incidence of comorbid factors. In this series, recovery rates were found to be higher in nontracheostomized patients than in tracheostomized patients. Patients can be carefully selected for observation versus tracheostomy at the time of diagnosis based on underlying medical conditions.
回顾16年间接受治疗的22例双侧先天性声带麻痹患者的治疗及预后情况，并探讨气管切开术在这些患者中的作用。
回顾性病历审查。
儿科三级医院。
22例被诊断为双侧先天性声带麻痹的儿科患者。
灵活或刚性诊断评估、气管切开术和声门旁正中移位术。
声带恢复和拔管情况。
平均随访50个月，22例双侧声带麻痹患者中有15例（68%）需要气管切开术以确保气道安全。在15例行气管切开术的患者中，10例成功拔管（8例自发恢复，2例需要行声门旁正中移位术）。这些行气管切开术的患者中有11例存在合并症，包括神经异常（中脑/脑干发育不全、阿诺德-基亚里畸形、全身性肌张力减退和发育迟缓）。在7例不需要气管切开术的患者中，6例恢复了声带功能（86%）。
在我们的22例双侧声带麻痹患者系列中，14例功能自发恢复。行气管切开术的患者合并症发生率较高。在本系列中，未行气管切开术的患者恢复率高于行气管切开术的患者。可根据潜在的医疗状况在诊断时仔细选择患者进行观察或气管切开术。
