Isaac Andre, Svystun Orysya, Johannsen Wendy, El-Hakim Hamdy
Pediatric Otolaryngology, Division of Otolaryngology Head & Neck Surgery, Departments of Surgery & Pediatrics, The Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada.
Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
J Otolaryngol Head Neck Surg. 2020 Jul 14;49(1):49. doi: 10.1186/s40463-020-00447-0.
To describe indications for injection augmentation (IA), endoscopic repair (ER) and conservative methods for the management of type 1 laryngeal cleft (LC1) and propose a management algorithm. We also aimed to compare success of IA and ER and determine independent predictors of treatment failure.
Retrospective study of patients diagnosed with LC1 at a Pediatric Otolaryngology referral centre between 2004 and 2016. All had pre-operative instrumental swallowing evaluation (VFSS/FEES), and were managed with a combination of conservative measures, IA and/or ER. We collected demographics, symptoms, comorbidities, VFSS/FEES results, and operative details. The primary outcome was symptom resolution by parental report. The secondary outcome was predictors of treatment failure.
88 patients were included in the analysis, with mean age 26 ± 25 months. Most presented with choking events (68%) or recurrent pneumonias (48%). In total, there were 55 IA performed and 45 ER. Of the patients who received IA, 19 required subsequent ER. 95% had symptom improvement, 67% had complete resolution. IA had a 56% long-term success rate, whereas that for ER was 85%. Tube feeding at initial evaluation was an independent predictor of treatment failure (HR 11.33 [1.51-84.97], p = 0.018).
LC1 can be effectively managed with a combination of IA and ER with favorable results. Failure to respond to IA does not preclude ER, and both have their role in management. Patients who are tube fed have a higher probability of treatment failure. We propose a management algorithm that includes reasoning for conservative approaches, and reduces exposure to general anesthesia.
描述1型喉裂（LC1）的注射填充（IA）、内镜修复（ER）及保守治疗方法的适应证，并提出一种治疗方案。我们还旨在比较IA和ER的成功率，并确定治疗失败的独立预测因素。
对2004年至2016年在一家儿科耳鼻喉科转诊中心诊断为LC1的患者进行回顾性研究。所有患者术前行吞咽功能仪器评估（视频荧光吞咽造影/纤维内镜吞咽功能检查），并采用保守措施、IA和/或ER联合治疗。我们收集了患者的人口统计学资料、症状、合并症、视频荧光吞咽造影/纤维内镜吞咽功能检查结果及手术细节。主要结局指标为家长报告的症状缓解情况。次要结局指标为治疗失败的预测因素。
88例患者纳入分析，平均年龄26±25个月。多数患者表现为呛咳（68%）或反复肺炎（48%）。共进行了55次IA和45次ER。接受IA治疗的患者中，19例随后需要ER治疗。95%的患者症状改善，67%的患者症状完全缓解。IA的长期成功率为56%，而ER为85%。初次评估时需鼻饲是治疗失败的独立预测因素（风险比11.33[1.51 - 84.97]，p = 0.018）。
IA和ER联合可有效治疗LC1，效果良好。对IA无反应并不排除ER治疗，二者在治疗中均有作用。需鼻饲的患者治疗失败的概率更高。我们提出一种治疗方案，其中包括保守治疗方法的依据，并减少全身麻醉的暴露。
