A new solution for neonatal bilateral vocal cord paralysis: Endoscopic arytenoid abduction lateropexy.
Bilateral vocal cord paralysis in early childhood is a life-threatening condition, which often requires immediate intervention. One of the treatment options is a quick, reversible simple suture vocal cord lateralizing technique, whereby the arytenoid cartilage is directly lateralized to the normal abducted position. Considering pediatric laryngeal anatomy, a small endolaryngeal thread guide instrument was designed for precise suture insertion.



New instrument validation.



Four newborns had inspiratory stridor immediately after birth; two had to be intubated. Laryngotracheoscopy revealed bilateral vocal cord paralysis. Unilateral, left-sided endoscopic arytenoid abduction lateropexy was performed with supraglottic jet ventilation on the 4th, 5th, 5th, and 27th day of life for the four patients, respectively.



All babies remained intubated for 3 to 7 days with an uncuffed tracheal tube. After extubation, no dyspnea or swallowing disorder occurred. A subjective quality of life questionnaire, laryngotracheoscopy, clinical growth charts, and voice analysis showed satisfactory functional results.



Minimally invasive, quick, reversible endoscopic arytenoid abduction lateropexy might be a more favorable solution for neonatal bilateral vocal cord paralysis than earlier treatment strategies. In one step, the airway can be maintained without the risk of any permanent damage to voice production. Good swallowing function is also preserved. The specially modified endolaryngeal thread guide instrument gives a fast and effective option for creating the lateralized arytenoid position even in the technically challenging surgical context of a neonate larynx.



4. Laryngoscope, 127:1608-1614, 2017.
Department of Otorhinolaryngology and Head and Neck Surgery, Stepping Hill Hospital, Stockport National Health Service Foundation Trust, Stockport, United Kingdom.
Shahram
S
Madani
Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary.
Ádám
Á
Bach
Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary.
Vera
V
Matievics
Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary.
Eszter
E
Erdélyi
Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary.
Balázs
B
Sztanó
Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, University of Szeged, Szeged, Hungary.
Ilona
I
Szegesdi
Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, U.S.A.
Paul F
PF
Castellanos
Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Szeged, Szeged, Hungary.
László
L
Rovó
D001193:Arytenoid Cartilage / Q000601:surgery*; D004417:Dyspnea / Q000151:congenital / Q000209:etiology / Q000601:surgery; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007828:Laryngoscopy / Q000295:instrumentation*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation*; D012135:Respiratory Sounds / Q000209:etiology; D013525:Surgical Instruments; D013536:Suture Techniques / Q000295:instrumentation*; D014826:Vocal Cord Paralysis / Q000151:congenital* / Q000601:surgery*
Bilateral vocal fold paralysis; dyspnea; endolaryngeal thread guide instrument; endoscopic arytenoid abduction lateropexy; laterofixation; neonatal