ABSTRACT
OBJECTIVES/HYPOTHESIS: To identify factors associated to increased risk of extra-laryngeal spread in pediatric patients with recurrent respiratory papillomatosis (RRP). STUDY DESIGN: Retrospective chart review. METHODS: A retrospective study was conducted evaluating the clinical charts of patients younger than 16 years with histopathologically confirmed RRP treated between January 2014 and December 2018. Characteristics of patients with and without extra-laryngeal disease dissemination were compared. Odds ratios were calculated and multivariate logistic regression analysis was performed. RESULTS: Data from 82 patients were analyzed. Mean age at symptom onset was 42 months. Fifteen (18.29%) patients had extra-laryngeal spread (ELS) at time of diagnosis and in four, the disease continued to spread to other sites. Of 67 patients with disease restricted to the larynx, 17 (25.37%) developed ELS during the disease course. Human papilloma virus (HPV) typing was performed in 49 (59.8%) patients; in 28 (57.1%) HPV subtype 6 was identified and in 21 (42.9%) HPV subtype 11. ELS was found in 11 patients with serotype 11 (52.38%) and in seven patients with serotype 6 (25%) (P = .048). Statistically significant differences for ELS were also found for age at diagnosis younger than 5 years (P = .045), presence of tracheostomy (P = .031), and need for adjuvant therapy (P = .010). CONCLUSIONS: Age at diagnosis of RRP younger than 5 years and presence of tracheostomy were factors related to ELS. A statistically significant association between infection with HPV subtype 11 and ELS were also observed. Adjuvant medication might be considered a protective factor against ELS. Laryngoscope, 131:1652-1656, 2021.
Subject(s)
Laryngeal Diseases/diagnosis , Papillomavirus Infections/diagnosis , Respiratory Tract Infections/diagnosis , Severity of Illness Index , Adolescent , Antiviral Agents/therapeutic use , Child , Child, Preschool , Combined Modality Therapy/methods , Combined Modality Therapy/statistics & numerical data , Human papillomavirus 11/isolation & purification , Human papillomavirus 6/isolation & purification , Humans , Infant , Laryngeal Diseases/therapy , Laryngeal Diseases/virology , Male , Microsurgery/statistics & numerical data , Papillomavirus Infections/therapy , Papillomavirus Infections/virology , Protective Factors , Respiratory Tract Infections/therapy , Respiratory Tract Infections/virology , Retrospective Studies , Risk Factors , Tracheostomy/statistics & numerical dataABSTRACT
La parálisis bilateral de cuerdas vocales (PBCV) es la segunda causa más frecuente de estridor neonatal. Nuestro objetivo es describir la demografía, etiología, comorbilidades y tratamientos instaurados. Materiales y métodos: Revisión retrospectiva de las historias clínicas de pacientes con diagnóstico de PBCV de 2011 a 2015. Resultados: Se incluyeron 47 pacientes. La edad media de diagnóstico fue un mes de vida, con predominio de sexo masculino (63%). El 59% fue por causa congénita y el 41% adquirida, por lo general idiopática y postoperatoria, respectivamente. Se realizó traqueostomía (TQT) en 42 pacientes (89%), sin diferencias significativas en relación con la causa. La recuperación de la movilidad cordal fue del 39% en toda la muestra, 44% en la congénita, 31% en la adquirida y 62,5% en la idiopática. A 5 pacientes se les realizó laringotraqueoplastia con injerto costal posterior y a un paciente cordectomía posterior. Todos fueron decanulados. A un paciente se le realizó lateralización cordal, evitando la TQT. Conclusión: Las causas congénitas fueron las más frecuentes, en su mayoría idiopáticas. Se registró una leve predilección por el sexo masculino. Un alto porcentaje de pacientes requirieron de TQT. La tasa de recuperación de la movilidad es mayor en causas idiopáticas. Se decanularon todos los pacientes operados, pero se requieren trabajos con mayor número de participantes, comparación de técnicas y evaluación de la deglución y la fonación de forma objetiva
Bilateral vocal cord paralysis (BVCP) is the second most common cause of neonatal stridor. The aim of this study was to describe the demographic features, aetiology, comorbidities, and management of our patients with BVCP. Material and methods: We conducted a retrospective review of the clinical charts of all patients diagnosed with BVCP seen at the Department of Respiratory Endoscopy between 2011 and 2015. Results: 47 patients were included. Mean age at diagnosis was 1 month and male sex predominated (63%). The aetiology was congenital in 59% and acquired in 41% of the infants. The cause was most frequently idiopathic in the former group and secondary to postoperative injury in the latter. Overall, 42 patients (89%) required tracheostomy, without statistically significant differences between the causes. Of all the patients, 39% regained vocal-cord mobility; 44% of those with congenital BVCP, 31% of those with acquired BVCP and 62.5% with idiopathic BVCP. In five patients a laryngotracheoplasty was performed with a posterior costal cartilage graft and one underwent posterior cordectomy. All were decannulated. In one patient vocal-cord lateralization was performed, avoiding tracheostomy. Conclusion: BVCP was most commonly of congenital cause and was mainly idiopathic within this group of patients, with a slight male preponderance. A high percentage of patients required tracheostomy. A higher recovery rate of vocal-cord mobility was observed in idiopathic BVCP, which allowed for successful decannulation. In this series, decannulation was possible in all patients that underwent surgery; however, further studies with comparison of techniques and objective assessment of swallowing and phonation are necessary
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Vocal Cord Paralysis/complications , Vocal Cord Paralysis/etiology , Vocal Cord Paralysis/therapy , Tracheostomy/methods , Retrospective Studies , Vocal Cord Paralysis/pathologyABSTRACT
Bilateral vocal cord paralysis (BVCP) is the second most common cause of neonatal stridor. The aim of this study was to describe the demographic features, aetiology, comorbidities, and management of our patients with BVCP. MATERIAL AND METHODS: We conducted a retrospective review of the clinical charts of all patients diagnosed with BVCP seen at the Department of Respiratory Endoscopy between 2011 and 2015. RESULTS: 47 patients were included. Mean age at diagnosis was 1 month and male sex predominated (63%). The aetiology was congenital in 59% and acquired in 41% of the infants. The cause was most frequently idiopathic in the former group and secondary to postoperative injury in the latter. Overall, 42 patients (89%) required tracheostomy, without statistically significant differences between the causes. Of all the patients, 39% regained vocal-cord mobility; 44% of those with congenital BVCP, 31% of those with acquired BVCP and 62.5% with idiopathic BVCP. In five patients a laryngotracheoplasty was performed with a posterior costal cartilage graft and one underwent posterior cordectomy. All were decannulated. In one patient vocal-cord lateralization was performed, avoiding tracheostomy. CONCLUSION: BVCP was most commonly of congenital cause and was mainly idiopathic within this group of patients, with a slight male preponderance. A high percentage of patients required tracheostomy. A higher recovery rate of vocal-cord mobility was observed in idiopathic BVCP, which allowed for successful decannulation. In this series, decannulation was possible in all patients that underwent surgery; however, further studies with comparison of techniques and objective assessment of swallowing and phonation are necessary.
