RESUMO
INTRODUCTION: Dyspnea caused by bilateral vocal cord paralysis often requires surgical intervention to prevent acute asphyxiation. The regeneration of the laryngeal nerves may last weeks or months and it is difficult to predict the outcome. In the past decades, several open and endoscopic surgical techniques have been introduced for treatment to avoid tracheostomy, however, these procedures with resection of the glottis resulted in irreversible changes in the laryngeal structure, thus the voice quality decreased over a long-term period. AIM: Endoscopic arytenoid abduction lateropexy is an accepted reversible, minimally invasive technique that provides an immediate patent airway by the lateralisation of the arytenoid cartilage with a suture. The aim of our study was to analyze the phonatory and respiratory outcomes of this treatment concept. METHOD: Two patients suffering from bilateral vocal cord palsy were treated with endoscopic arytenoid abduction lateropexy. After recovery of the vocal cord movements, the sutures were removed. Spirometric and phoniatric results of the two patients were analysed after suture removal. RESULTS: Good spirometric parameters and normal voice quality were detected in both cases. CONCLUSIONS: These results prove the high reversibility of the minimally invasive endoscopic arytenoid abduction lateropexy. Lateralization suture can be removed in the case of vocal cord movement recovery, and phonation may be physiological. Orv Hetil. 2018; 159(29): 1188-1192.
Assuntos
Cartilagem Aritenoide/cirurgia , Dispneia/cirurgia , Paralisia das Pregas Vocais/cirurgia , Adulto , Dispneia/congênito , Dispneia/etiologia , Endoscopia/métodos , Humanos , Resultado do Tratamento , Paralisia das Pregas Vocais/congênito , Qualidade da VozRESUMO
OBJECTIVES/HYPOTHESIS: 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. STUDY DESIGN: New instrument validation. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:1608-1614, 2017.
Assuntos
Cartilagem Aritenoide/cirurgia , Laringoscopia/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Instrumentos Cirúrgicos , Técnicas de Sutura/instrumentação , Paralisia das Pregas Vocais/congênito , Paralisia das Pregas Vocais/cirurgia , Dispneia/congênito , Dispneia/etiologia , Dispneia/cirurgia , Feminino , Humanos , Recém-Nascido , Masculino , Sons Respiratórios/etiologiaAssuntos
Humanos , Masculino , Recém-Nascido , Células Cultivadas , Técnicas Citológicas , Cartilagem Articular/lesões , Dispneia/congênito , Circulação Pulmonar , Síndrome de Cimitarra/diagnóstico , Síndrome de Cimitarra/patologia , Terapia Baseada em Transplante de Células e Tecidos/tendências , Anormalidades Cardiovasculares , Diagnóstico por Imagem , Anormalidades do Sistema Respiratório , Doenças RespiratóriasAssuntos
Doenças da Laringe/diagnóstico , Laringoscopia/métodos , Transtornos de Deglutição/congênito , Diagnóstico Diferencial , Dispneia/congênito , Desenho de Equipamento , Feminino , Humanos , Lactente , Doenças da Laringe/congênito , Laringoscópios , Masculino , Paralisia das Pregas Vocais/congênito , Paralisia das Pregas Vocais/diagnósticoRESUMO
The authors describe a rare case of congenital dyspnoë caused by "pulmonary artery sling". They indicate a role of early diagnosis based on additional diagnostic investigation as bronchoscopy, bronchography and oesophagoradiography. Surgical correction of the vascular ring allows to maintain the child's life and gives possibility of normal further development.
Assuntos
Dispneia/congênito , Broncografia/métodos , Broncoscopia/métodos , Dispneia/diagnóstico , Dispneia/cirurgia , Humanos , Recém-Nascido , Masculino , Artéria Pulmonar/cirurgiaRESUMO
Primary congenital pulmonary hypoplasia, defined as congenital pulmonary hypoplasia occurring in the absence of other congenital anomalies, is an exceedingly rare condition of unknown aetiology. We report on two cases that presented as severe progressive respiratory failure immediately after birth in siblings of a consanguinous marriage, and we postulate that a genetic aetiology may be responsible for the arrest of lung maturation in utero. The possibility of a genetic component to the aetiology has not been previously documented in the literature.