Ayoub Noel, Balakrishnan Karthik, Meister Kara, Grimm David, Johnson April, Maida Kelli, Sidell Douglas Ryan
Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA.
Lucile Packard Children's Hospital Pediatric Aerodigestive and Airway Reconstruction Center, USA; Department of Otolaryngology - Head and Neck Surgery, Division of Pediatric Otolaryngology Stanford University School of Medicine, USA; Lucile Packard Children's Hospital Center for Pediatric Voice and Swallowing Disorders, USA.
Int J Pediatr Otorhinolaryngol. 2023 May;168:111542. doi: 10.1016/j.ijporl.2023.111542. Epub 2023 Mar 31.
Injection laryngoplasty (IL) is commonly performed for unilateral vocal fold immobility (UVFI). However, the safety and efficacy in patients <1 year of age are not widely recognized. This study analyzes the safety and swallow outcomes in a cohort of patients <1 year who underwent IL.
This retrospective analysis evaluated patients at a tertiary children's institution between 2015 and 2022. Patients were eligible if they underwent IL for UVFI and were <1 year at time of injection. Baseline characteristics, perioperative data, oral diet tolerance, and preoperative and postoperative swallow data were collected.
49 patients were included, 12 (24%) of whom were premature. The average age at injection was 3.9 months (SD 3.8), time from UVFI onset to injection 1.3 months (2.0), and weight at injection 4.8 kg (2.1). The baseline American Association of Anesthesiologists physical status classification scores were 2 (14%), 3 (61%), and 4 (24%). 89% of patients had improvements in objective swallow function postoperatively. Of the 35 patients who were preoperatively enterally-dependent and did not have medical circumstances precluding advancement to oral feeds, 32 (n = 91%) tolerated an oral diet postoperatively. There were no long-term sequelae. Two patients had intraoperative laryngospasm, one intraoperative bronchospasm, and one with subglottic and posterior glottic stenosis was intubated for <12 h for increased work of breathing.
IL is a safe and effective intervention that can reduce aspiration and improve diet in patients <1 year old. This procedure can be considered at institutions with the appropriate personnel, resources, and infrastructure.
注射喉成形术（IL）常用于治疗单侧声带麻痹（UVFI）。然而，1岁以下患者接受该手术的安全性和有效性尚未得到广泛认可。本研究分析了一组1岁以下接受IL治疗患者的安全性和吞咽结果。
本回顾性分析评估了2015年至2022年期间一家三级儿童机构的患者。如果患者因UVFI接受IL治疗且注射时年龄小于1岁，则符合纳入标准。收集了患者的基线特征、围手术期数据、口服饮食耐受性以及术前和术后吞咽数据。
纳入49例患者，其中12例（24%）为早产儿。注射时的平均年龄为3.9个月（标准差3.8），从UVFI发作到注射的时间为1.3个月（2.0），注射时体重为4.8千克（2.1）。美国麻醉医师协会身体状况分类基线评分分别为2分（14%）、3分（61%）和4分（24%）。89%的患者术后客观吞咽功能有所改善。术前依赖肠内营养且无医学情况妨碍转为口服喂养的35例患者中，32例（91%）术后耐受口服饮食。无长期后遗症。2例患者术中发生喉痉挛，1例术中发生支气管痉挛，1例声门下和声门后狭窄患者因呼吸做功增加插管时间小于12小时。
IL是一种安全有效的干预措施，可减少1岁以下患者的误吸并改善饮食。在具备适当人员、资源和基础设施的机构可考虑开展此手术。
