Bertelsen Caitlin, Jacobson Lia, Osterbauer Beth, Hochstim Christian
Caruso Department of Otolaryngology-Head and Neck Surgery, Los Angeles, California, U.S.A.
Division of Otolaryngology-Head and Neck Surgery, Children's Hospital of Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California, U.S.A.
Laryngoscope. 2019 Jul;129(7):1699-1705. doi: 10.1002/lary.27436. Epub 2018 Oct 23.
The major morbidity of unilateral vocal fold immobility (UVFI) in children is due to aspiration. Early injection laryngoplasty (IL) can decrease aspiration risk; however, this has not been well studied in pediatric otolaryngology. This study examines safety and efficacy of early IL in children.
Retrospective review of pediatric patients undergoing IL with any injectate between 2006 and 2017 within 6 months of onset of UVFI. Outcomes included diet pre- and postprocedure, incidence of aspiration-related sequelae, and adverse events.
Seventeen patients met eligibility criteria. Ten (58.8%) were males. Median age was 8 months (interquartile range, 2 months-11.5 years). All patients had prior surgeries; the largest subgroup (11 patients, 64.7%) had UVFI after repair of a congenital cardiac defect. Other causes included thyroidectomy, high vagal injury, and prolonged intubation. Sixteen patients underwent swallowing evaluation prior to IL and 14 patients required dietary modifications due to aspiration risk. Consistency and/or volume of oral intake improved after IL in 10 (71.4%) of them. Five patients underwent gastrostomy tube placement for significant oromotor incoordination. Children with congenital cardiac defects had more previous surgeries (3.0 ± 0.4 vs. 1.2 ± 0.2, P = .006) and were more likely to require G-tube placement due to poor feeding despite IL (45% vs. 0%, P = .05). No patients experienced adverse events due to IL; in particular, none experienced airway symptoms requiring intubation.
Early IL in pediatric patients with UVFI is safe and can reduce aspiration and improve oral intake. Future studies should elucidate patient subgroups most likely to benefit from this intervention.
4 Laryngoscope, 129:1699-1705, 2019.
儿童单侧声带麻痹（UVFI）的主要发病原因是误吸。早期注射喉成形术（IL）可降低误吸风险；然而，这在小儿耳鼻咽喉科领域尚未得到充分研究。本研究旨在探讨早期IL在儿童中的安全性和有效性。
回顾性分析2006年至2017年间在UVFI发病6个月内接受任何注射剂IL治疗的儿科患者。观察指标包括术前和术后饮食、误吸相关后遗症的发生率以及不良事件。
17例患者符合纳入标准。其中10例（58.8%）为男性。中位年龄为8个月（四分位间距，2个月至11.5岁）。所有患者均曾接受过手术；最大的亚组（11例患者，64.7%）在先天性心脏病修复术后出现UVFI。其他原因包括甲状腺切除术、高位迷走神经损伤和长时间插管。16例患者在接受IL治疗前接受了吞咽评估，14例患者因误吸风险需要调整饮食。其中10例（71.4%）患者在接受IL治疗后口腔摄入的食物稠度和/或量有所改善。5例患者因明显的口面运动不协调而接受了胃造瘘管置入术。患有先天性心脏病的儿童既往接受的手术更多（3.0±0.4比1.2±0.2，P = 0.006），并且尽管接受了IL治疗，但由于喂养困难而更有可能需要置入胃造瘘管（45%比0%，P = 0.05）。没有患者因IL治疗而出现不良事件；特别是，没有患者出现需要插管的气道症状。
对于患有UVFI的儿科患者，早期IL是安全的，并且可以减少误吸并改善经口摄入量。未来的研究应阐明最有可能从这种干预措施中获益的患者亚组。
4 《喉镜》，2019年，第129卷，第1699 - 1705页
