内镜下环状环后切开加肋软骨移植治疗小儿双侧声带麻痹：回顾性机构系列和文献比较

IF 1.3 4区医学 Q3 OTORHINOLARYNGOLOGY

International journal of pediatric otorhinolaryngology Pub Date : 2025-08-23 DOI:10.1016/j.ijporl.2025.112533

Alhanouf A. Alhedaithy , Zahra Almoumen , Mohammed Y. Alyousef , Deema R. Alhudaithi , Mohammed Sulaiman Alsayyari , Ahmed Alammar

{"title":"内镜下环状环后切开加肋软骨移植治疗小儿双侧声带麻痹：回顾性机构系列和文献比较","authors":"Alhanouf A. Alhedaithy , Zahra Almoumen , Mohammed Y. Alyousef , Deema R. Alhudaithi , Mohammed Sulaiman Alsayyari , Ahmed Alammar","doi":"10.1016/j.ijporl.2025.112533","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>The study aimed to evaluate the clinical outcomes of endoscopic posterior cricoid split with costal cartilage grafting (EPCSCG) in pediatric patients with bilateral vocal cord paralysis (BVCP) and compare these results with those in the existing literature.</div></div><div><h3>Methods</h3><div>This retrospective case series included pediatric patients (≤18 years) who underwent EPCSCG between 2017 and 2024 at a tertiary care center. Data were extracted from operative reports, clinical notes, and endoscopy records. The primary outcomes included tracheostomy status, decannulation rate, breathing function (Empey Index), swallowing outcomes (dysphagia outcome and severity scale [DOSS]), and voice assessment (Voice Handicap Index–10 [VHI-10]). A structured literature review was also conducted for comparison.</div></div><div><h3>Results</h3><div>The study included nine patients (median age: 3 years, interquartile range: 1–6 years). Four patients underwent preoperative tracheostomy, and all underwent successful decannulation. Tracheostomy was avoided entirely in the remaining five patients, resulting in a 100 % tracheostomy-free rate. The Empey Index improved postoperatively in two-thirds of the tested patients. Voice outcomes remained impaired with a moderately elevated mean VHI-10 score of 20.7. No major complications occurred, and additional surgeries were performed in four patients, including balloon dilations for subglottic stenosis, partial laser arytenoidectomy, right vocal cord suture lateralization, adenoidectomy, and tracheocutaneous fistula repair. A literature comparison revealed a wide variability in decannulation rates (28.6–100 %) and inconsistent reporting of voice and swallowing outcomes.</div></div><div><h3>Conclusion</h3><div>EPCSCG is a safe and effective surgical option for pediatric patients with BVCP that achieves excellent decannulation and swallowing outcomes. Persistent dysphonia remains a limitation, highlighting the need for comprehensive preoperative and postoperative functional assessments.</div></div>","PeriodicalId":14388,"journal":{"name":"International journal of pediatric otorhinolaryngology","volume":"197 ","pages":"Article 112533"},"PeriodicalIF":1.3000,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Endoscopic posterior cricoid split with costal cartilage graft in pediatric bilateral vocal cord paralysis: A retrospective institutional series and literature comparison\",\"authors\":\"Alhanouf A. Alhedaithy , Zahra Almoumen , Mohammed Y. Alyousef , Deema R. Alhudaithi , Mohammed Sulaiman Alsayyari , Ahmed Alammar\",\"doi\":\"10.1016/j.ijporl.2025.112533\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>The study aimed to evaluate the clinical outcomes of endoscopic posterior cricoid split with costal cartilage grafting (EPCSCG) in pediatric patients with bilateral vocal cord paralysis (BVCP) and compare these results with those in the existing literature.</div></div><div><h3>Methods</h3><div>This retrospective case series included pediatric patients (≤18 years) who underwent EPCSCG between 2017 and 2024 at a tertiary care center. Data were extracted from operative reports, clinical notes, and endoscopy records. The primary outcomes included tracheostomy status, decannulation rate, breathing function (Empey Index), swallowing outcomes (dysphagia outcome and severity scale [DOSS]), and voice assessment (Voice Handicap Index–10 [VHI-10]). A structured literature review was also conducted for comparison.</div></div><div><h3>Results</h3><div>The study included nine patients (median age: 3 years, interquartile range: 1–6 years). Four patients underwent preoperative tracheostomy, and all underwent successful decannulation. Tracheostomy was avoided entirely in the remaining five patients, resulting in a 100 % tracheostomy-free rate. The Empey Index improved postoperatively in two-thirds of the tested patients. Voice outcomes remained impaired with a moderately elevated mean VHI-10 score of 20.7. No major complications occurred, and additional surgeries were performed in four patients, including balloon dilations for subglottic stenosis, partial laser arytenoidectomy, right vocal cord suture lateralization, adenoidectomy, and tracheocutaneous fistula repair. A literature comparison revealed a wide variability in decannulation rates (28.6–100 %) and inconsistent reporting of voice and swallowing outcomes.</div></div><div><h3>Conclusion</h3><div>EPCSCG is a safe and effective surgical option for pediatric patients with BVCP that achieves excellent decannulation and swallowing outcomes. Persistent dysphonia remains a limitation, highlighting the need for comprehensive preoperative and postoperative functional assessments.</div></div>\",\"PeriodicalId\":14388,\"journal\":{\"name\":\"International journal of pediatric otorhinolaryngology\",\"volume\":\"197 \",\"pages\":\"Article 112533\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2025-08-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International journal of pediatric otorhinolaryngology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0165587625003209\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"OTORHINOLARYNGOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International journal of pediatric otorhinolaryngology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0165587625003209","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}

引用次数: 0

摘要

目的评价内镜下环状环后切开联合肋软骨移植术（EPCSCG）治疗小儿双侧声带麻痹（BVCP）的临床效果，并与已有文献进行比较。方法本回顾性病例系列包括2017年至2024年在三级保健中心接受EPCSCG的儿科患者（≤18岁）。数据来自手术报告、临床记录和内窥镜检查记录。主要结局包括气管造口状态、脱管率、呼吸功能（empy指数）、吞咽结局（吞咽困难结局和严重程度量表[DOSS]）和语音评估（语音障碍指数-10 [VHI-10]）。为了进行比较，我们还进行了结构化的文献综述。结果纳入9例患者，中位年龄3岁，四分位数间距1-6岁。4例患者术前行气管切开术，均成功脱管。其余5例患者完全避免气管切开术，使气管切开术率达到100%。三分之二的患者术后空指数有所改善。语音结果仍然受损，平均VHI-10评分中度升高，为20.7。4例患者均行球囊扩张治疗声门下狭窄、激光部分杓状体切除术、右侧声带缝合侧化、腺样体切除术和气管皮瘘修复术。文献比较显示，脱管率的差异很大（28.6 - 100%），声音和吞咽结果的报告也不一致。结论epcscg是小儿BVCP患者安全有效的手术选择，可获得良好的脱管和吞咽效果。持续性语音障碍仍然是一个局限性，强调需要进行全面的术前和术后功能评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Endoscopic posterior cricoid split with costal cartilage graft in pediatric bilateral vocal cord paralysis: A retrospective institutional series and literature comparison

Objective

The study aimed to evaluate the clinical outcomes of endoscopic posterior cricoid split with costal cartilage grafting (EPCSCG) in pediatric patients with bilateral vocal cord paralysis (BVCP) and compare these results with those in the existing literature.

Methods

This retrospective case series included pediatric patients (≤18 years) who underwent EPCSCG between 2017 and 2024 at a tertiary care center. Data were extracted from operative reports, clinical notes, and endoscopy records. The primary outcomes included tracheostomy status, decannulation rate, breathing function (Empey Index), swallowing outcomes (dysphagia outcome and severity scale [DOSS]), and voice assessment (Voice Handicap Index–10 [VHI-10]). A structured literature review was also conducted for comparison.

Results

The study included nine patients (median age: 3 years, interquartile range: 1–6 years). Four patients underwent preoperative tracheostomy, and all underwent successful decannulation. Tracheostomy was avoided entirely in the remaining five patients, resulting in a 100 % tracheostomy-free rate. The Empey Index improved postoperatively in two-thirds of the tested patients. Voice outcomes remained impaired with a moderately elevated mean VHI-10 score of 20.7. No major complications occurred, and additional surgeries were performed in four patients, including balloon dilations for subglottic stenosis, partial laser arytenoidectomy, right vocal cord suture lateralization, adenoidectomy, and tracheocutaneous fistula repair. A literature comparison revealed a wide variability in decannulation rates (28.6–100 %) and inconsistent reporting of voice and swallowing outcomes.

Conclusion

EPCSCG is a safe and effective surgical option for pediatric patients with BVCP that achieves excellent decannulation and swallowing outcomes. Persistent dysphonia remains a limitation, highlighting the need for comprehensive preoperative and postoperative functional assessments.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

International journal of pediatric otorhinolaryngology 医学-耳鼻喉科学

CiteScore

3.20

自引率

6.70%

发文量

276

审稿时长

62 days

期刊介绍： The purpose of the International Journal of Pediatric Otorhinolaryngology is to concentrate and disseminate information concerning prevention, cure and care of otorhinolaryngological disorders in infants and children due to developmental, degenerative, infectious, neoplastic, traumatic, social, psychiatric and economic causes. The Journal provides a medium for clinical and basic contributions in all of the areas of pediatric otorhinolaryngology. This includes medical and surgical otology, bronchoesophagology, laryngology, rhinology, diseases of the head and neck, and disorders of communication, including voice, speech and language disorders.