Children's Hospital of Fudan University, Department of Otolaryngology-Head and Neck Surgery, Shanghai, China.
Children's Hospital of Fudan University, Department of Otolaryngology-Head and Neck Surgery, Shanghai, China.
Braz J Otorhinolaryngol. 2023 Mar-Apr;89(2):271-278. doi: 10.1016/j.bjorl.2022.05.007. Epub 2022 Jun 9.
Bilateral Vocal Fold Paralysis (BVFP) is a rare but significant resource of respiratory distress in neonates and infants. The objective of this study was to evaluate the efficacy and functional outcomes of Endoscopic Percutaneous Suture Lateralization (EPSL) for the treatment of BVFP in neonates and infants.
A case series study of nine patients undergoing EPSL for BVFP between January 2019 and June 2021 was conducted. All patients were candidates for tracheostomy prior to EPSL. Demographic features including gender, age at diagnosis and surgery, main symptoms, airway comorbidities, airway support, and etiology were collected preoperatively. Patients were evaluated for breathing, swallowing and phonation postoperatively. Surgical success was defined as the ability to avoid tracheostomy. Functional Endoscopic Evaluation of Swallowing (FEES) was conducted to identify aspiration. Voice evaluation was based on clinical observation.
Nine patients underwent ten EPSL procedures (one in the left vocal fold, and nine in the right vocal fold). Eight patients (8/9) were able to successfully avoid tracheostomy and feed orally without aspiration after the procedure. One patient experienced clinical improvement in respiratory support requirements and underwent laparoscopic nissen and gastrostomy tube placement. At the last follow-up, two patients regained normal voice, two patients had mild dysphonia, and five patients had moderate dysphonia. Five patients showed partial return of the contralateral vocal fold function.
EPSL is an effective and safe treatment for neonatal and infantal BVFP, which enables patients free from tracheostomy without significant impact on swallowing function or phonation.
Level 4.
双侧声带麻痹（BVFP）是新生儿和婴儿呼吸窘迫的罕见但重要原因。本研究旨在评估内镜经皮缝线侧移术（EPSL）治疗新生儿和婴儿 BVFP 的疗效和功能结局。
对 2019 年 1 月至 2021 年 6 月期间因 BVFP 接受 EPSL 的 9 例患者进行了病例系列研究。所有患者在接受 EPSL 前均为气管切开术的候选者。收集了术前的人口统计学特征，包括性别、诊断和手术时的年龄、主要症状、气道合并症、气道支持和病因。术后对患者的呼吸、吞咽和发音进行评估。手术成功定义为能够避免气管切开术。进行功能性内镜吞咽评估（FEES）以确定是否存在误吸。根据临床观察进行嗓音评估。
9 例患者共接受 10 次 EPSL 手术（1 次在左侧声带，9 次在右侧声带）。8 例患者（8/9）术后能够成功避免气管切开术，并能经口进食且无误吸。1 例患者呼吸支持需求的临床改善，并接受腹腔镜胃底折叠术和胃造口管放置。末次随访时，2 例患者恢复正常嗓音，2 例患者轻度发音困难，5 例患者中度发音困难。5 例患者显示对侧声带功能部分恢复。
EPSL 是治疗新生儿和婴儿 BVFP 的有效且安全的方法，可使患者无需气管切开术，且对吞咽功能或发音无明显影响。
4 级。
