Surgical interventions for pediatric unilateral vocal fold paralysis: A systematic review and meta-analysis

Mateus Morais Aires; Camila Barbosa Marinho; Silvio José de Vasconcelos

doi:10.1016/j.ijporl.2020.110553

Surgical interventions for pediatric unilateral vocal fold paralysis: A systematic review and meta-analysis

Int J Pediatr Otorhinolaryngol. 2021 Feb:141:110553. doi: 10.1016/j.ijporl.2020.110553. Epub 2020 Dec 11.

Authors

Mateus Morais Aires¹, Camila Barbosa Marinho², Silvio José de Vasconcelos²

Affiliations

¹ Department of Otolaryngology-Head and Neck Surgery of Hospital Das Clínicas da Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil. Electronic address: mateusairesotorrino@gmail.com.
² Department of Otolaryngology-Head and Neck Surgery of Hospital Das Clínicas da Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil.

PMID: 33333340
DOI: 10.1016/j.ijporl.2020.110553

Abstract

Objective: To evaluate outcomes of injection laryngoplasty (IL) and laryngeal reinnervation for the treatment of pediatric Unilateral Vocal Fold Paralysis (UVFP), especially on swallowing and quality of voice.

Methods: A literature review was performed in Medline/PubMed and Cochrane Library, following PRISMA guidelines, with no constraints on publication date. We included studies in English, Portuguese or Spanish about surgical treatment for UVFP on the pediatric population (0-21 years) that documented outcomes for one of the following techniques: IL or laryngeal reinnervation. Study characteristics, patient demographics, technical aspects of each procedure, complications, and outcomes for voice and swallowing were extracted. A meta-analysis with inverse variance, random-effects model was performed.

Results: The PRISMA approach yielded 22 studies, totaling 267 patients. Seven reinnervation articles were included in meta-analysis for maximum phonation time (MPT) and quality of voice measured by Grade, Roughness, Breathiness, Asthenia and Strain (GRBAS) scale. Cardiac surgery had caused UVFP in 62.8% (142/226) of the cases. The main indication for IL was aspiration and for reinnervation was dysphonia. For IL, there was an improvement of 84.5% (confidence interval [CI] 82.6-88.4%) in swallowing and 81.4% (CI 74.6-88.1%) in voice. For reinnervation, there was an improvement of 91.6% (CI 88.2-94.9%) in swallowing and 96.8% (CI 95.5-98.0%) in voice. We found an increase of 6.19 s (CI 1.00 to 11.38) in MPT and a mean difference in GRBAS sum of -3.53 points (CI -6.15 to -0.91) after reinnervation.

Conclusion: Retrospective cohort studies suggest that injection laryngoplasty and reinnervation are both effective in improving swallowing and voice in children with UVFP. There was clinical evidence of improvement in the MPT and GRBAS scale meta-analysis in patients undergoing reinnervation.

Keywords: Child; Infant; Injection laryngoplasty; Laryngeal reinnervation; Surgery; Systematic review; Unilateral vocal fold paralysis; Vocal cord paralysis.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Child
Dysphonia* / surgery
Humans
Laryngoplasty*
Retrospective Studies
Treatment Outcome
Vocal Cord Paralysis* / surgery
Vocal Cords