JAMA：小儿喉返神经再支配治疗麻痹性发声困难安全有效

To study the effectiveness of ansa–recurrent laryngeal nerve laryngeal reinnervation to improve glottal incompetence causing dysphonia and dysphagia for children with unilateral vocal fold paralysis.

We reviewed a series of consecutive cases treated from January 1, 2006, through December 31, 2011.

Otolaryngology division of a children's hospital.

Thirteen children with unilateral vocal fold paralysis.

Main Outcome Measures  

Surgical complications, parent surrogate quality-of-life measures, global overall assessment of improvement, and auditory perceptual assessment.

Thirteen children underwent laryngeal reinnervation. Ages ranged from 2.2 to 8.8 years (mean [SD] age, 5.3 [2.6] years). No major complications were identified. Nine children had preoperative and 6- to 12-month postoperative data on voice and swallowing. Mean parental global voice rating (0 indicates no voice; 100%, normal voice) changed from 43% (range, 20%-65%) preoperatively to 79% (range, 50%-100%) postoperatively. Regarding perceptual assessment, the mean GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) Rating Scale sum score (0 indicates normal voice; 15, profoundly abnormal voice) improved from 6.3 to 2.9. Parental assessment of dysphagia with liquids also improved for all children with preoperative symptoms and worsened for none.

Conclusions  

Our early experience suggests that ansa–recurrent laryngeal nerve laryngeal reinnervation is a safe and effective treatment for unilateral vocal fold paralysis with symptomatic dysphonia and dysphagia in young children. The procedure has advantages compared with other treatments. This option should be discussed with parents when the paralysis is identified. The child should be observed for several years in the event that voice and swallowing symptoms from glottal incompetence do not improve.