title: Endoscopic anterior-posterior cricoid split for pediatric bilateral vocal fold paralysis.
abstract: Children with bilateral true vocal fold immobility (BTVFI) may present with significant airway distress necessitating tracheostomy. The objective of this study was to review our preliminary experience with the anterior-posterior cricoid split (APCS), an endoscopic intervention used as an alternative to tracheostomy in children with BTVFI.
  
  
  
  Multicenter review.
  
  
  
  A review of patients undergoing endoscopic APCS for BTVFI at four institutions was performed. Patients were evaluated for the ability to ventilate without the requirement for tracheostomy or reintubation. Additional data extracted included the duration of intubation following APCS, the requirement for additional procedures, and demographics. Surgical success was defined as the ability to avoid tracheostomy and to cap or decannulate without respiratory symptoms if a tracheostomy was present prior to APCS.
  
  
  
  Nineteen APCS procedures were performed between October 2010 and June 2016. There were 12 male patients, the mean age at APCS was 4.7 months. BTVFI was primarily idiopathic (58%) and associated with other comorbidities (74%). All patients were candidates for tracheostomy prior to APCS. Fourteen patients (74%) were considered surgical successes. Of the unsuccessful patients, three (66%) required tracheostomy following APCS, and one was treated with a posterior cartilage graft. There was one nonsurgical mortality greater than 2 months after APCS and thought to be unrelated to the airway.
  
  
  
  Endoscopic APCS appears to be a safe and effective intervention for pediatric BTVFI. Under the correct circumstances, this can be performed as a single procedure, obviating tracheostomy. Further study is warranted.
  
  
  
  4. Laryngoscope, 128:257-263, 2018.
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.|Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.|Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rutter
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.|Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.|Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
authors.forename: Catherine K
authors.initials: CK
authors.lastname: Hart
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.|Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.|Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
authors.forename: Alessandro de
authors.initials: A
authors.lastname: Alarcon
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Sam J
authors.initials: SJ
authors.lastname: Daniel
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, U.S.A.
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Parikh
authors.affiliation: Department of Otorhinolaryngology, Mayo Clinic College of Medicine, Rochester, Minnesota, U.S.A.
authors.forename: Karthik
authors.initials: K
authors.lastname: Balakrishnan
authors.affiliation: Division of Pediatric Otolaryngology, Oregon Health & Science University Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon, U.S.A.
authors.forename: Derek
authors.initials: D
authors.lastname: Lam
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington, U.S.A.
authors.forename: Kaalan
authors.initials: K
authors.lastname: Johnson
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, California, U.S.A.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Sidell
mesh_terms: D003413:Cricoid Cartilage / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000601:surgery*
keywords: Pediatrics; airway (nonsleep); endoscopic; laryngology; vocal fold paralysis