Laser arytenoidectomy in the management of bilateral vocal cord paralysis in children.
OBJECTIVE
To analyse the efficacy of CO(2) laser arytenoidectomy in the management of bilateral vocal cord paralysis in children.


METHODS
Retrospective series of 17 patients who underwent laser arytenoidectomy for bilateral vocal cord between 1995 and 2008 in a tertiary care institution. All patients had bilateral laryngeal paralysis, in isolation (n=5) or associated with concomitant airway conditions (n=12). All cases had anterior prolapse of the arytenoids with partial obstruction of the airway on inspiration. 12/17 patients (70.5%) were tracheotomy-dependant, 2/17 were in-extubatable, and 3/17 had severe airway limitation, effort dyspnea and poor sleep pattern. Main outcome measures were decannulation rate for patients with tracheotomy, occurrence of aspiration and quality of voice.


RESULTS
The mean age was 2.8 years old. 9/12 patients with tracheotomy (75%) were decannulated with a median delay of 2 months (2 days to 18 months). Both of the intubated patients were extubated with a median delay of 36h. One of the decannulated patients who re-presented with a residual dyspnea after the arytenoidectomy was improved by a further laser cordotomy. 2/17 patients (11.7%) had post-operative persistent aspirations (with pneumopathies in one case), 5/17 patients were dysphonic, 3 improved with speech therapy and 2 with intracordal lipoinjection.


CONCLUSIONS
Laser arytenoidectomy is effective for improving the breathing in children presenting with a bilateral vocal fold paralysis associated with obstructive arytenoid prolapse. Results are good as a first-line surgery or following laryngo-tracheal surgery. Voice outcomes are satisfactory. However, aspiration is a rare complication.
Aubry
Karine
K
ENT Department, Children's Hospital Trousseau, 26 avenue Docteur Arnold Netter, 75012 Paris, France. aubryorl@aol.com
Leboulanger
Nicolas
N
Harris
Robert
R
Genty
Erwan
E
Denoyelle
Françoise
F
Garabedian
Erea-Noël
EN
D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery; D001193:Arytenoid Cartilage / Q000601:surgery*; D002357:Cartilage Diseases / Q000150:complications / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004417:Dyspnea / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D055092:Laryngomalacia / Q000150:complications / Q000601:surgery; D054020:Lasers, Gas; D008297:Male; D011183:Postoperative Complications; D011391:Prolapse; D053120:Respiratory Aspiration / Q000209:etiology; D012189:Retrospective Studies; D014135:Tracheal Stenosis / Q000150:complications / Q000601:surgery; D014826:Vocal Cord Paralysis / Q000150:complications / Q000601:surgery*