Endoscopic anterior-posterior cricoid split for pediatric bilateral vocal fold paralysis

Michael J. Rutter, Catherine K. Hart, Alessandro de Alarcon, Sam Daniel, Sanjay R. Parikh, Karthik Balakrishnan, Derek Lam, Kaalan Johnson, Douglas R. Sidell

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Objectives/Hypothesis: Children with bilateral true vocal fold immobility (BTVFI) may present with significant airway distress necessitating tracheostomy. The objective of this study was to review our preliminary experience with the anterior-posterior cricoid split (APCS), an endoscopic intervention used as an alternative to tracheostomy in children with BTVFI. Study Design: Multicenter review. Methods: A review of patients undergoing endoscopic APCS for BTVFI at four institutions was performed. Patients were evaluated for the ability to ventilate without the requirement for tracheostomy or reintubation. Additional data extracted included the duration of intubation following APCS, the requirement for additional procedures, and demographics. Surgical success was defined as the ability to avoid tracheostomy and to cap or decannulate without respiratory symptoms if a tracheostomy was present prior to APCS. Results: Nineteen APCS procedures were performed between October 2010 and June 2016. There were 12 male patients, the mean age at APCS was 4.7 months. BTVFI was primarily idiopathic (58%) and associated with other comorbidities (74%). All patients were candidates for tracheostomy prior to APCS. Fourteen patients (74%) were considered surgical successes. Of the unsuccessful patients, three (66%) required tracheostomy following APCS, and one was treated with a posterior cartilage graft. There was one nonsurgical mortality greater than 2 months after APCS and thought to be unrelated to the airway. Conclusions: Endoscopic APCS appears to be a safe and effective intervention for pediatric BTVFI. Under the correct circumstances, this can be performed as a single procedure, obviating tracheostomy. Further study is warranted.

Original languageEnglish (US)
JournalLaryngoscope
DOIs
StateAccepted/In press - 2017

Fingerprint

Vocal Cords
Tracheostomy
Paralysis
Pediatrics
Intubation
Multicenter Studies
Cartilage
Comorbidity
Demography
Transplants
Mortality

Keywords

  • Airway (nonsleep)
  • Endoscopic
  • Laryngology
  • Pediatrics
  • Vocal fold paralysis

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Rutter, M. J., Hart, C. K., Alarcon, A. D., Daniel, S., Parikh, S. R., Balakrishnan, K., ... Sidell, D. R. (Accepted/In press). Endoscopic anterior-posterior cricoid split for pediatric bilateral vocal fold paralysis. Laryngoscope. https://doi.org/10.1002/lary.26547

Endoscopic anterior-posterior cricoid split for pediatric bilateral vocal fold paralysis. / Rutter, Michael J.; Hart, Catherine K.; Alarcon, Alessandro de; Daniel, Sam; Parikh, Sanjay R.; Balakrishnan, Karthik; Lam, Derek; Johnson, Kaalan; Sidell, Douglas R.

In: Laryngoscope, 2017.

Research output: Contribution to journalArticle

Rutter, MJ, Hart, CK, Alarcon, AD, Daniel, S, Parikh, SR, Balakrishnan, K, Lam, D, Johnson, K & Sidell, DR 2017, 'Endoscopic anterior-posterior cricoid split for pediatric bilateral vocal fold paralysis', Laryngoscope. https://doi.org/10.1002/lary.26547
Rutter, Michael J. ; Hart, Catherine K. ; Alarcon, Alessandro de ; Daniel, Sam ; Parikh, Sanjay R. ; Balakrishnan, Karthik ; Lam, Derek ; Johnson, Kaalan ; Sidell, Douglas R. / Endoscopic anterior-posterior cricoid split for pediatric bilateral vocal fold paralysis. In: Laryngoscope. 2017.
@article{fb648e3e33fd4eccb335c6034b86ee52,
title = "Endoscopic anterior-posterior cricoid split for pediatric bilateral vocal fold paralysis",
abstract = "Objectives/Hypothesis: Children with bilateral true vocal fold immobility (BTVFI) may present with significant airway distress necessitating tracheostomy. The objective of this study was to review our preliminary experience with the anterior-posterior cricoid split (APCS), an endoscopic intervention used as an alternative to tracheostomy in children with BTVFI. Study Design: Multicenter review. Methods: A review of patients undergoing endoscopic APCS for BTVFI at four institutions was performed. Patients were evaluated for the ability to ventilate without the requirement for tracheostomy or reintubation. Additional data extracted included the duration of intubation following APCS, the requirement for additional procedures, and demographics. Surgical success was defined as the ability to avoid tracheostomy and to cap or decannulate without respiratory symptoms if a tracheostomy was present prior to APCS. Results: Nineteen APCS procedures were performed between October 2010 and June 2016. There were 12 male patients, the mean age at APCS was 4.7 months. BTVFI was primarily idiopathic (58{\%}) and associated with other comorbidities (74{\%}). All patients were candidates for tracheostomy prior to APCS. Fourteen patients (74{\%}) were considered surgical successes. Of the unsuccessful patients, three (66{\%}) required tracheostomy following APCS, and one was treated with a posterior cartilage graft. There was one nonsurgical mortality greater than 2 months after APCS and thought to be unrelated to the airway. Conclusions: Endoscopic APCS appears to be a safe and effective intervention for pediatric BTVFI. Under the correct circumstances, this can be performed as a single procedure, obviating tracheostomy. Further study is warranted.",
keywords = "Airway (nonsleep), Endoscopic, Laryngology, Pediatrics, Vocal fold paralysis",
author = "Rutter, {Michael J.} and Hart, {Catherine K.} and Alarcon, {Alessandro de} and Sam Daniel and Parikh, {Sanjay R.} and Karthik Balakrishnan and Derek Lam and Kaalan Johnson and Sidell, {Douglas R.}",
year = "2017",
doi = "10.1002/lary.26547",
language = "English (US)",
journal = "Laryngoscope",
issn = "0023-852X",
publisher = "John Wiley and Sons Inc.",

}

TY - JOUR

T1 - Endoscopic anterior-posterior cricoid split for pediatric bilateral vocal fold paralysis

AU - Rutter, Michael J.

AU - Hart, Catherine K.

AU - Alarcon, Alessandro de

AU - Daniel, Sam

AU - Parikh, Sanjay R.

AU - Balakrishnan, Karthik

AU - Lam, Derek

AU - Johnson, Kaalan

AU - Sidell, Douglas R.

PY - 2017

Y1 - 2017

N2 - Objectives/Hypothesis: Children with bilateral true vocal fold immobility (BTVFI) may present with significant airway distress necessitating tracheostomy. The objective of this study was to review our preliminary experience with the anterior-posterior cricoid split (APCS), an endoscopic intervention used as an alternative to tracheostomy in children with BTVFI. Study Design: Multicenter review. Methods: A review of patients undergoing endoscopic APCS for BTVFI at four institutions was performed. Patients were evaluated for the ability to ventilate without the requirement for tracheostomy or reintubation. Additional data extracted included the duration of intubation following APCS, the requirement for additional procedures, and demographics. Surgical success was defined as the ability to avoid tracheostomy and to cap or decannulate without respiratory symptoms if a tracheostomy was present prior to APCS. Results: Nineteen APCS procedures were performed between October 2010 and June 2016. There were 12 male patients, the mean age at APCS was 4.7 months. BTVFI was primarily idiopathic (58%) and associated with other comorbidities (74%). All patients were candidates for tracheostomy prior to APCS. Fourteen patients (74%) were considered surgical successes. Of the unsuccessful patients, three (66%) required tracheostomy following APCS, and one was treated with a posterior cartilage graft. There was one nonsurgical mortality greater than 2 months after APCS and thought to be unrelated to the airway. Conclusions: Endoscopic APCS appears to be a safe and effective intervention for pediatric BTVFI. Under the correct circumstances, this can be performed as a single procedure, obviating tracheostomy. Further study is warranted.

AB - Objectives/Hypothesis: Children with bilateral true vocal fold immobility (BTVFI) may present with significant airway distress necessitating tracheostomy. The objective of this study was to review our preliminary experience with the anterior-posterior cricoid split (APCS), an endoscopic intervention used as an alternative to tracheostomy in children with BTVFI. Study Design: Multicenter review. Methods: A review of patients undergoing endoscopic APCS for BTVFI at four institutions was performed. Patients were evaluated for the ability to ventilate without the requirement for tracheostomy or reintubation. Additional data extracted included the duration of intubation following APCS, the requirement for additional procedures, and demographics. Surgical success was defined as the ability to avoid tracheostomy and to cap or decannulate without respiratory symptoms if a tracheostomy was present prior to APCS. Results: Nineteen APCS procedures were performed between October 2010 and June 2016. There were 12 male patients, the mean age at APCS was 4.7 months. BTVFI was primarily idiopathic (58%) and associated with other comorbidities (74%). All patients were candidates for tracheostomy prior to APCS. Fourteen patients (74%) were considered surgical successes. Of the unsuccessful patients, three (66%) required tracheostomy following APCS, and one was treated with a posterior cartilage graft. There was one nonsurgical mortality greater than 2 months after APCS and thought to be unrelated to the airway. Conclusions: Endoscopic APCS appears to be a safe and effective intervention for pediatric BTVFI. Under the correct circumstances, this can be performed as a single procedure, obviating tracheostomy. Further study is warranted.

KW - Airway (nonsleep)

KW - Endoscopic

KW - Laryngology

KW - Pediatrics

KW - Vocal fold paralysis

UR - http://www.scopus.com/inward/record.url?scp=85014591186&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85014591186&partnerID=8YFLogxK

U2 - 10.1002/lary.26547

DO - 10.1002/lary.26547

M3 - Article

C2 - 28271539

AN - SCOPUS:85014591186

JO - Laryngoscope

JF - Laryngoscope

SN - 0023-852X

ER -