Endoscopic Arytenoid Abduction Lateropexy for the treatment of Neonatal Bilateral Vocal Cord Paralysis – long-term results

Publication date: Available online 22 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Balázs Sztanó, Ádám Bach, Vera Matievics, Eszter Erdélyi, Ilona Szegesdi, Christopher T. Wootten, László Rovó

ABSTRACT

OBJECTIVES

Bilateral vocal cord paralysis often causes severe dyspnea requiring an early airway intervention in neonates. Endoscopic arytenoid abduction lateropexy (EAAL) with suture is a quick, reversible, minimally-invasive vocal cord lateralizing technique to enlarge the glottis. The arytenoid cartilage is directly lateralized to a normal abducted position. It can be performed even in early childhood with the recently-introduced pediatric endoscopic thread guide instrument. The long-term results and the stability of the lateralization were evaluated.

METHODS

Three newborns had inspiratory stridor immediately after birth. Laryngo-tracheoscopy revealed bilateral vocal cord paralysis. Unilateral, left-sided endoscopic arytenoid abduction lateropexy was performed with supraglottic jet ventilation. The follow-up period was >3 years.

RESULTS

After extubation on the 4-7^th postoperative day no dyspnea or swallowing disorder occurred. Laryngo-tracheoscopy, clinical growth charts and voice analysis showed satisfactory functional results.

CONCLUSIONS

The endoscopic arytenoid abduction lateropexy might be a favorable solution for neonatal bilateral vocal cord paralysis. In one step, airway patency can be achieved without irreversible damage to the glottic structures. Normal swallowing function was preserved. The results are durable, and neither medialization nor dyspnea re-appeared during observation.

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