Department of Otolaryngology-Head and Neck Surgery of Hospital Das Clínicas da Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
Department of Otolaryngology-Head and Neck Surgery of Hospital Das Clínicas da Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.
Int J Pediatr Otorhinolaryngol. 2021 Feb;141:110553. doi: 10.1016/j.ijporl.2020.110553. Epub 2020 Dec 11.
To evaluate outcomes of injection laryngoplasty (IL) and laryngeal reinnervation for the treatment of pediatric Unilateral Vocal Fold Paralysis (UVFP), especially on swallowing and quality of voice.
A literature review was performed in Medline/PubMed and Cochrane Library, following PRISMA guidelines, with no constraints on publication date. We included studies in English, Portuguese or Spanish about surgical treatment for UVFP on the pediatric population (0-21 years) that documented outcomes for one of the following techniques: IL or laryngeal reinnervation. Study characteristics, patient demographics, technical aspects of each procedure, complications, and outcomes for voice and swallowing were extracted. A meta-analysis with inverse variance, random-effects model was performed.
The PRISMA approach yielded 22 studies, totaling 267 patients. Seven reinnervation articles were included in meta-analysis for maximum phonation time (MPT) and quality of voice measured by Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scale. Cardiac surgery had caused UVFP in 62.8% (142/226) of the cases. The main indication for IL was aspiration and for reinnervation was dysphonia. For IL, there was an improvement of 84.5% (confidence interval [CI] 82.6-88.4%) in swallowing and 81.4% (CI 74.6-88.1%) in voice. For reinnervation, there was an improvement of 91.6% (CI 88.2-94.9%) in swallowing and 96.8% (CI 95.5-98.0%) in voice. We found an increase of 6.19 s (CI 1.00 to 11.38) in MPT and a mean difference in GRBAS sum of -3.53 points (CI -6.15 to -0.91) after reinnervation.
Retrospective cohort studies suggest that injection laryngoplasty and reinnervation are both effective in improving swallowing and voice in children with UVFP. There was clinical evidence of improvement in the MPT and GRBAS scale meta-analysis in patients undergoing reinnervation.
评估注射性声带成形术（IL）和喉返神经再支配术治疗小儿单侧声带麻痹（UVFP）的疗效，特别是在吞咽和嗓音方面。
按照 PRISMA 指南，在 Medline/PubMed 和 Cochrane 图书馆进行文献回顾，对发表日期没有限制。我们纳入了关于小儿（0-21 岁）UVFP 外科治疗的英文、葡萄牙文或西班牙文研究，这些研究记录了以下一种技术的结果：IL 或喉返神经再支配术。提取研究特征、患者人口统计学、每种手术的技术方面、并发症以及嗓音和吞咽的结果。采用逆方差、随机效应模型进行荟萃分析。
PRISMA 方法共检索到 22 项研究，共计 267 例患者。7 项再支配术的文章纳入了最大发音时间（MPT）和嗓音质量的 meta 分析，嗓音质量通过等级、粗糙度、呼吸声、无力和紧张度（GRBAS）量表进行评估。62.8%（142/226）的病例由心脏手术引起的 UVFP。IL 的主要适应证是吸入，再支配的主要适应证是发音困难。对于 IL，吞咽功能改善了 84.5%（置信区间 [CI] 82.6-88.4%），嗓音改善了 81.4%（CI 74.6-88.1%）。对于再支配，吞咽功能改善了 91.6%（CI 88.2-94.9%），嗓音改善了 96.8%（CI 95.5-98.0%）。我们发现再支配后 MPT 增加了 6.19 秒（CI 1.00 至 11.38），GRBAS 总分平均差值为-3.53 分（CI-6.15 至-0.91）。
回顾性队列研究表明，注射性声带成形术和喉返神经再支配术在改善小儿单侧声带麻痹患者的吞咽和嗓音方面均有效。再支配患者的 MPT 和 GRBAS 量表 meta 分析显示出临床改善。
