Otolaryngology, CHI Crumlin Hospital Dublin, Ireland.
Otolaryngology, CHI Crumlin Hospital Dublin, Ireland.
Int J Pediatr Otorhinolaryngol. 2022 Jul;158:111159. doi: 10.1016/j.ijporl.2022.111159. Epub 2022 Apr 26.
Bilateral vocal cord immobility (BVCI) is a leading cause of stridor and airway obstruction in neonates which may arise idiopathically, as a result of birth trauma, or in the setting of Central nervous system lesions such as Arnold-Chiari malformation. Although many children with BVCI may be managed conservatively, surgical intervention may be necessary in those patients with ongoing upper airway obstruction. Many interventions have been described including, tracheostomy, cordotomy, cricoid splitting procedures, and arytenoidectomy. Vocal cord suture lateralization has the advantage of being both reversible and less morbid than other surgical interventions for BVCI. This study describes a novel variation of the suture lateralization procedure which aids in correct placement of the suture thus minimizing multiple needle passes and associated laryngeal edema.
A retrospective chart review was undertaken of five patients undergoing suture lateralization of the vocal cord for BVCI at a single institution over a 10 year period. Post-operative voice and swallow outcomes were recorded.
Of five patients undergoing this procedure four returned to normal diet. One was diagnosed with a progressive neurological disorder and was persistently fed via gastrostomy tube. Three of the five patients spontaneously recovered vocal cord function and went on to have normal voice after suture removal.
Suture lateralization is a safe and effective means of alleviating upper airway obstruction in BVCI. It has the advantages of being reversable and minimally invasive; however, optimal suture placement is both vital and challenging. The novel technique described in this study allows identification of landmarks as and aid to suture placement thus reducing the need for multiple needle passes into the lumen of the larynx.
双侧声带固定不动（BVCI）是导致新生儿喘鸣和气道阻塞的主要原因，可能是特发性的，也可能是由于出生创伤引起的，或者是在中枢神经系统病变（如 Arnold-Chiari 畸形）的情况下发生的。尽管许多患有 BVCI 的儿童可以保守治疗，但对于持续存在上呼吸道阻塞的患者，可能需要手术干预。已经描述了许多干预措施，包括气管切开术、声带切开术、环状软骨切开术和杓状软骨切除术。声带缝合侧移的优点是既可以逆转，又比其他用于治疗 BVCI 的手术干预方法的创伤更小。本研究描述了一种新的声带缝合侧移术式的改良方法，有助于正确放置缝线，从而最大限度地减少多次针穿过喉和相关的喉水肿。
对一家机构在 10 年内对 5 例因 BVCI 而行声带缝合侧移术的患者进行了回顾性图表分析。记录术后声音和吞咽结果。
在 5 例接受该手术的患者中，有 4 例恢复了正常饮食。1 例被诊断为进行性神经疾病，持续通过胃造口管喂养。5 例患者中有 3 例声带功能自发恢复，在缝线拆除后声音正常。
缝线侧移是缓解 BVCI 上呼吸道阻塞的一种安全有效的方法。它具有可逆性和微创性的优点；然而，最佳缝线位置至关重要且具有挑战性。本研究中描述的新技术可以识别和辅助缝线放置的标志，从而减少多次将缝线穿过喉腔的需要。
