Division of Pediatric Otolaryngology-Head and Neck Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada2Division of Pediatric Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouv.
Division of Pediatric Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
JAMA Otolaryngol Head Neck Surg. 2015 Jul;141(7):654-60. doi: 10.1001/jamaoto.2015.0680.
The most widely used surgical interventions for pediatric unilateral vocal cord paralysis include injection laryngoplasty, thyroplasty, and laryngeal reinnervation. Despite increasing interest in surgical interventions for unilateral vocal cord paralysis in children, the surgical outcomes data in children are scarce.
To appraise and summarize the available evidence for pediatric unilateral vocal cord paralysis surgical strategies.
MEDLINE (1946-2014) and EMBASE (1980-2014) were searched for publications that described the results of laryngoplasty, thyroplasty, or laryngeal reinnervation for pediatric unilateral vocal cord paralysis. Further studies were identified from bibliographies of relevant studies, gray literature, and annual scientific assemblies. Two reviewers independently appraised the selected studies for quality, level of evidence, and risk of bias as well as extracted data, including unilateral vocal cord paralysis origin, voice outcomes, swallowing outcomes, and adverse events.
Of 366 identified studies, the inclusion criteria were met by 15 studies: 6 observational studies, 6 case series, and 3 case reports. All 36 children undergoing laryngeal reinnervation (8 studies) had improvement or resolution of dysphonia. Of 31 children receiving injection laryngoplasty (6 studies), most experienced improvement in voice quality, speech, swallowing, aspiration, and glottic closure. Of 12 children treated by thyroplasty (5 studies), 2 experienced resolution of dysphonia, 4 had some improvement, and 4 had no improvement (2 patients had undocumented outcomes). Thyroplasty resolved or improved aspiration in 7 of 8 patients.
Published studies suggest that reinnervation may be the most effective surgical intervention for children with dysphonia; however, long-term follow-up data are lacking. With the exception of polytetrafluoroethylene injections, injection laryngoplasty was reported to be a relatively safe, nonpermanent, and effective option for most children with dysphonia. Thyroplasty appears to have fallen out favor in recent years because of difficulty in performing this procedure in children under local anesthesia, but it continues to be a viable option for children with aspiration.
小儿单侧声带麻痹最常用的手术干预措施包括注射性喉成形术、甲状软骨成形术和喉神经再支配术。尽管儿童单侧声带麻痹的手术干预措施越来越受到关注，但儿童的手术结果数据仍然很少。
评估和总结小儿单侧声带麻痹手术策略的现有证据。
通过 MEDLINE（1946-2014 年）和 EMBASE（1980-2014 年）检索描述儿童单侧声带麻痹喉成形术、甲状软骨成形术或喉神经再支配术结果的出版物。从相关研究的参考文献、灰色文献和年度科学会议中进一步确定研究。两名评审员独立评估所选研究的质量、证据水平和偏倚风险，并提取数据，包括单侧声带麻痹的起源、嗓音结果、吞咽结果和不良事件。
在 366 项已识别的研究中，有 15 项研究符合纳入标准：6 项观察性研究、6 项病例系列研究和 3 项病例报告。所有 36 例接受喉神经再支配术（8 项研究）的儿童均有发音障碍的改善或解决。31 例接受注射性喉成形术（6 项研究）的儿童中，大多数患者的嗓音质量、言语、吞咽、误吸和声门闭合得到改善。12 例接受甲状软骨成形术治疗的儿童（5 项研究）中，2 例发音障碍得到解决，4 例有所改善，4 例无改善（2 例患者结果未记录）。甲状软骨成形术解决或改善了 8 例患者中的 7 例误吸。
已发表的研究表明，神经再支配术可能是儿童发音障碍最有效的手术干预措施；然而，缺乏长期随访数据。除了聚四氟乙烯注射外，注射性喉成形术被报道为大多数发音障碍儿童相对安全、非永久性和有效的选择。近年来，由于在局部麻醉下进行该手术对儿童有难度，甲状软骨成形术的应用已减少，但它仍是儿童误吸的可行选择。
