Pediatrics & Neonatology
Volume 49, Issue 5 , Pages 183-188, October 2008

Applications of Flexible Bronchoscopy in Infants with Congenital Vocal Cord Paralysis: A 12-Year Experience

Division of Pediatric Pulmonology, Department of Pediatrics and Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center

Received 12 May 2008; received in revised form 16 June 2008; accepted 19 September 2008.

Article Outline

Background

Congenital vocal cord paralysis (VCP) is a common cause of congenital stridor. Before the widespread application of flexible bronchoscopy (FB) by pediatricians, congenital stridor in infants was usually attributed to laryngomalacia. Prompt recognition and careful follow-up is crucial for the management of congenital VCP.

Methods

We performed a retrospective chart review of newborn infants with congenital VCP diagnosed by FB over a 12-year period.

Results

During the 12-year period, FB was performed on a total of 356 infants. Fifteen (4%) infants were diagnosed with congenital VCP. There were eight males and seven females and the mean age at diagnosis was 76.6 days. Stridor with respiratory distress was the most prominent presenting symptom. The majority (93%, 14/15) demonstrated bilateral VCP, while one patient (7%) had unilateral VCP. Seven of the 15 (46%) patients had idiopathic VCP, while eight (54%) had VCP associated with neuromuscular disorders. Tracheotomy was necessary in four patients (26%). None of them underwent further surgical interventions. Spontaneous recovery occurred in 10 patients (71%), and of these, 90% (9/10) were treated without tracheotomy.

Conclusion

In order to allow prompt diagnosis of congenital VCP, FB should be performed in every newborn infant with stridor. Patients with congenital VCP should undergo additional imaging studies to detect any associated neurological abnormalities and intrathoracic comorbidities. The majority of patients can be managed conservatively and monitored carefully using serial FB. Corrective surgery should be reserved for those with a lack of resolution at prolonged follow-up, and those with significant comorbidities.

Key Words:  congenital vocal cord paralysis , flexible bronchoscopy , stridor , tracheotomy

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References 

  1. Ungkanont K , Friedman EM , Sulek M . A retrospective analysis of airway endoscopy in patients less than 1-month old . Laryngoscope . 1998;108:1724–1728
  2. Murty GE , Shinkwin C , Gibbin KP . Bilateral vocal fold paralysis in infants: Tracheostomy or not? . J Laryngol Otol . 1994;108:329–331
  3. de Jong AL , Kuppersmith RB , Sulek M , Friedman EM . Vocal cord paralysis in infants and children . Otolaryngol Clin North Am . 2000;33:131–149
  4. Holinger PH , Brown WT . Congenital webs, cysts, laryngoceles and other anomalies of the larynx . Ann Otol Rhinol Laryngol . 1967;76:744–752
  5. Wood RE . Spelunking in the pediatric airways: explorations with the flexible fiberoptic bronchoscope . Pediatr Clin North Am . 1984;31:785–799
  6. Gentile RD , Miller RH , Woodson GE . Vocal cord paralysis in children 1 year of age and younger . Ann Otol Rhinol Laryngol . 1986;95:622–625
  7. Shah RK , Harvey-Woodnorth G , Glynn A , Nuss RC . Perceptual voice characteristics in pediatric unilateral vocal fold paralysis . Otolaryngol Head Neck Surg . 2006;134:618–621
  8. de Gaudemar I , Roudaire M , Francois M , Nancy P . Outcome of laryngeal paralysis in neonates: a long-term retrospective study of 113 cases . Int J Pediatr Otorhinolaryngol . 1996;34:101–110
  9. Ravilochan K , Seetharam W , Dinakar I . Vocal cord para lysis in neuraxial malformation . Indian J Pediatr . 1983;50:557–559
  10. Linder A , Lindholm CE . Laryngologic management of infants with the Chiari II syndrome . Int J Pediatr Otorhinolaryngol . 1997;39:187–197
  11. Cohen SR , Geller KA , Birns JW , Thompson JW . Laryngeal paralysis in children: a long-term retrospective study . Ann Otol Rhinol Laryngol . 1982;91:417–424
  12. Ross DA , Ward PH . Central vocal cord paralysis and paresis presenting as laryngeal stridor in children . Laryngoscope . 1990;100:10–13
  13. Daya H , Hosni A , Bejar-Solar I , Evans JN , Bailey CM . Pediatric vocal fold paralysis: a long-term retrospective study . Arch Otolaryngol Head Neck Surg . 2000;126:21–25
  14. Zbar RI , Smith RJ . Vocal fold paralysis in infants twelve months of age and younger . Otolaryngol Head Neck Surg . 1996;114:18–21

PII: S1875-9572(09)60006-1

doi:10.1016/S1875-9572(09)60006-1

Pediatrics & Neonatology
Volume 49, Issue 5 , Pages 183-188, October 2008

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