© Borgis - New Medicine 3/2008, s. 70-72
SURGICAL TREATMENT OF BILATERAL VOCAL CORD PARALYSIS IN CHILDREN
Department of Paediatric Otorhinolaryngology, Medical University of Warsaw
Head of Department: Prof Mieczysław Chmielik, MD, PhD
Aim: Unilateral or bilateral paralysis of the vocal cord is the second most common cause of stridor in neonates after laryngomalacia. Symptoms may be present at or shortly after birth, or they may be delayed in onset. The symptoms of unilateral paralysis include a hoarse cry and stridor on deep inspiration. Children with unilateral vocal cord paralysis will most commonly recover spontaneously or compensate. Children with bilateral paralysis will manifest upper airway problems. Symptoms vary from total obstruction to slight problems with exercise tolerance. If the obstruction of the airway is severe the patients will require tracheotomy. Failure of recovery of normal motion and function or failure of development of complete compensation with persistence of symptoms may necessitate surgical treatment of laryngeal paralysis.
Material and methods: In the Department of Paediatric ENT in Warsaw, between 1998 and 2008, 58 children with dyspnoea and voice disorders were admitted. Six patients aged from 1 to 14 years underwent lateral fixation of the vocal cord.
Results: We performed lateral fixation of vocal cords in 6 cases with good results.
Conclusions: Lateral fixation of the vocal cords is a safe and effective endoscopic technique. The procedure is easy to perform satisfactorily in children´s larynges.
Vocal cord paralysis is a frequent problem in children. It may cause the patient little or no difficulty, or it can be life-threatening. Vocal cord paralysis presents a variety of symptoms. Successful management of vocal cord paralysis depends upon accurate diagnosis and methods to treat the specific disorders.
The position of the vocal cords usually correlates with the symptoms.
Paralysis of the vocal cords may be bilateral or unilateral and complete or partial. The recurrent laryngeal nerve and vagus nerve may be paralyzed because of disease or injury anywhere along its course from the brain stem to the larynx. The left vocal cord is the more commonly paralyzed of the two, probably because its course is longer and more vulnerable than that of the right. There are a lot of causes of vocal cord paralysis: neck trauma, mediastinal and thoracic surgery, cardiovascular pathology, neurofibroma of parapharyngeal space, lymphoma, central nervous dysfunction, severe head injury, Arnold-Chiari malformation, multiple congenital anomalies, toxic and metabolic causes, inflammation and tumours of the larynx (1, 2, 5).
Children with unilateral vocal cord paralysis will most commonly recover spontaneously or compensate. In either situation, no intervention will be required. Most surgeons agree that recovery will take place within six months to a year of onset. In most patients who do not recover recurrent nerve function, the contralateral vocal fold will compensate by moving across the midline to achieve satisfactory glottic closure (6, 7, 9).
Children with bilateral paralysis will manifest upper airway problems. Symptoms vary from total obstruction to slight problems with exercise tolerance. If the obstruction of the airway is severe the patients will require tracheotomy. Once the airway is stabilized, consideration can be given to further management of bilateral vocal cord paralysis, if indicated. Complete paralysis can occur with injury to the vagus nerve above the point of departure of the superior laryngeal nerve. Dyspnoea occurs when the breathing surface of the glottis is decreased by 3/4 (4, 7, 10). Central paralysis can occur with various disorders such as perinatal asphyxia, Arnold-Chiari malformation, multiple congenital anomalies of the central nervous system, Charcot-Marie-Tooth syndrome, Guillain-Barre syndrome, cerebral vascular haemorrhage and others (2, 3, 5, 8). Peripheral paralysis can be caused by the following: mediastinal and thoracic surgery, neck surgery, neck trauma, toxic and metabolic causes, inflammatory factors.
Because of the correlation with other pathologies, children with vocal cord paralysis should be investigated for intrathoracic and intracranial pathology.
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