Sztanó Balázs, Bach Ádám, Matievics Vera, Erdélyi Eszter, Szegesdi Ilona, Wootten Christopher T, Rovó László
Department of Otorhinolaryngology and Head and Neck Surgery Faculty of Medicine, University of Szeged, Szeged, Hungary.
Department of Otorhinolaryngology and Head and Neck Surgery Faculty of Medicine, University of Szeged, Szeged, Hungary.
Int J Pediatr Otorhinolaryngol. 2019 Apr;119:147-150. doi: 10.1016/j.ijporl.2019.01.032. Epub 2019 Jan 22.
Bilateral vocal cord paralysis often causes severe dyspnea requiring an early airway intervention in neonates. Endoscopic arytenoid abduction lateropexy (EAAL) with suture is a quick, reversible, minimally-invasive vocal cord lateralizing technique to enlarge the glottis. The arytenoid cartilage is directly lateralized to a normal abducted position. It can be performed even in early childhood with the recently-introduced pediatric endoscopic thread guide instrument. The long-term results and the stability of the lateralization were evaluated.
Three newborns had inspiratory stridor immediately after birth. Laryngo-tracheoscopy revealed bilateral vocal cord paralysis. Unilateral, left-sided endoscopic arytenoid abduction lateropexy was performed with supraglottic jet ventilation. The follow-up period was >3 years.
After extubation on the 4-7th postoperative day no dyspnea or swallowing disorder occurred. Laryngo-tracheoscopy, clinical growth charts and voice analysis showed satisfactory functional results.
The endoscopic arytenoid abduction lateropexy might be a favorable solution for neonatal bilateral vocal cord paralysis. In one step, airway patency can be achieved without irreversible damage to the glottic structures. Normal swallowing function was preserved. The results are durable, and neither medialization nor dyspnea re-appeared during observation.
双侧声带麻痹常导致严重呼吸困难，需要对新生儿进行早期气道干预。内镜下杓状软骨外展固定术（EAAL）是一种快速、可逆、微创的声带外移技术，可扩大声门。杓状软骨直接外移至正常外展位。即使在幼儿期，使用最近推出的儿科内镜导丝器械也可进行该手术。评估了长期效果和外移的稳定性。
3例新生儿出生后立即出现吸气性喘鸣。喉镜检查显示双侧声带麻痹。采用声门上喷射通气进行单侧、左侧内镜下杓状软骨外展固定术。随访时间超过3年。
术后第4 - 7天拔管后，未出现呼吸困难或吞咽障碍。喉镜检查、临床生长图表和嗓音分析显示功能结果良好。
内镜下杓状软骨外展固定术可能是治疗新生儿双侧声带麻痹的理想方法。一步即可实现气道通畅，且不会对声门结构造成不可逆损伤。吞咽功能得以保留。结果持久，观察期间未出现内移或呼吸困难复发。
