Research Committee of the Young Otolaryngologists of the International Federation of Otorhinolaryngological Societies, Paris, France.
Department of Otolaryngology-Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.
J Otolaryngol Head Neck Surg. 2024 Jan-Dec;53:19160216241291807. doi: 10.1177/19160216241291807.
To review the current literature about surgical treatments of pediatric bilateral vocal fold paralysis (PBVFP).
A systematic review of the current literature in PubMed, Scopus, and Cochrane Library regarding etiologies and management of PBVFP was performed until November 2023 according to PRISMA statements. Quality assessment was assessed with Methodological Index for Non-Randomized Studies (MINORS) tool.
Of the 211 screened articles, 26 were included accounting for 320 patients. The etiologies included idiopathic (42.2%), congenital (19.7%), neurological (16.9%), or post-surgical (9.5%) pediatric bilateral vocal cord paralysis (PBVCP). Patients were decannulated in 76.7% of cases without laryngeal procedure. Decannulation was achieved in 84.6%, 66.6%, 83.3%, 80.0%, and 62.5% of cases of laterofixation of the vocal fold, cricoid split approaches, partial or total arytenoidectomy, uni- or bilateral transverse cordotomy, and selective laryngeal reinnervation, respectively. Dyspnea/stridor relief, swallowing, or voice quality outcomes were used in some studies, which reported conflicting results. Revision and complications varied between studies, with complications mainly involving edema, granuloma, or aspirations. Revision was required in 6.4%, 12.9%, and 40.0% of cases that underwent laterofixation of the vocal fold, arytenoidectomy, and cricoid split procedures, respectively. There was substantial heterogeneity across studies in inclusion criteria, procedures, and outcomes.
The management of PBVFP may involve several temporary or permanent surgical procedures that are associated with overall subjective improvements of symptoms, and laryngeal findings. The retrospective design of studies, the small number of cohorts, the lack of objective outcomes, and the differences between teams regarding procedure timing and features limit drawing reliable conclusions about the superiority of one technique over others.
回顾关于小儿双侧声带麻痹（PBVFP）的外科治疗的当前文献。
根据 PRISMA 声明，在 PubMed、Scopus 和 Cochrane Library 中对有关 PBVFP 的病因和治疗的当前文献进行了系统回顾，截至 2023 年 11 月。使用非随机研究方法学指数（MINORS）工具评估质量评估。
在筛选出的 211 篇文章中，有 26 篇纳入了 320 名患者。病因包括特发性（42.2%）、先天性（19.7%）、神经源性（16.9%）或术后（9.5%）小儿双侧声带麻痹（PBVCP）。76.7%的患者在无需喉部手术的情况下拔管。在后期声带固定、环状软骨切开术、部分或全部杓状软骨切除术、单侧或双侧横带状切开术以及选择性喉返神经再支配的患者中，拔管成功率分别为 84.6%、66.6%、83.3%、80.0%和 62.5%。呼吸困难/喘鸣缓解、吞咽或声音质量结果在一些研究中使用，但报告的结果相互矛盾。修订和并发症在研究之间有所不同，并发症主要涉及水肿、肉芽肿或吸入。在接受后期声带固定、杓状软骨切除术和环状软骨切开术的患者中，分别有 6.4%、12.9%和 40.0%需要进行修订。纳入标准、手术和结果在研究之间存在很大的异质性。
PBVFP 的治疗可能涉及几种临时或永久性手术，这些手术与症状和喉部发现的整体主观改善有关。研究的回顾性设计、队列数量少、缺乏客观结果以及团队在手术时机和特征方面的差异，限制了对一种技术优于其他技术的可靠结论的得出。
