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Pediatric Airway Surgery: Advances in Evaluation and Endoscopic Management

  • PEDIATRIC OTOLARYNGOLOGY: Pediatric Airway and Voice (J Ongkasuwan, Section Editor)
  • Published:
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Abstract

Purpose of Review

Pediatric airway evaluation and surgery have evolved over time to involve less invasive techniques in order to facilitate quicker recovery and potentially less discomfort. Over the past decade, new indications, techniques, and data have emerged to support the use of these techniques routinely. In this article, we present techniques for evaluation and outcomes for endoscopic management of the pediatric larynx and review relevant recent publications relevant to pediatric endoscopic airway surgery.

Recent Findings

Laryngeal ultrasound has been shown to be an effective modality for evaluating vocal fold motion and potentially for evaluating laryngeal lesions. Innovations in surgical techniques include epiglottopexy for supraglottic obstruction, new airway balloons for dilating subglottic stenosis, and endoscopic cricoid split with or without a cartilage graft and vocal fold suture lateralization for bilateral vocal fold immobility.

Summary

Less invasive techniques of diagnosis and management are viable options for pediatric airway patients and may replace or serve as adjuncts to traditional modalities.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Santos D, Mitchell R. The history of pediatric airway reconstruction. Laryngoscope. 2010;120:815–20.

    Article  Google Scholar 

  2. Raghavendra BN, Horii SC, Reede DL, Rumancik WM, Persky M, Bergeron T. Sonographic anatomy of the larynx, with particular reference to the vocal cords. J Ultrasound Med. 1987;6:225–30.

    Article  CAS  Google Scholar 

  3. Liu YC, McElwee T, Musso M, Rosenberg TL, Ongkasuwan J. The reliability of flexible nasolaryngoscopy in the identification of vocal fold movement impairment in young infants. Int J Pediatr Otorhinolaryngol. 2017;100:157–9.

    Article  Google Scholar 

  4. Ooi LL. B-mode real-time ultrasound assessment of vocal cord function in recurrent laryngeal nerve palsy. Ann Acad Med Singap. 1992;21:214–6.

    CAS  PubMed  Google Scholar 

  5. Ooi LL, Chan HS, Soo KC. Color Doppler imaging for vocal cord palsy. Head Neck. 1995;17:20–3.

    Article  CAS  Google Scholar 

  6. Zhang WQ, Lambert EM, Ongkasuwan J. Point of care, clinician-performed laryngeal ultrasound and pediatric vocal fold movement impairment. Int J Pediatr Otorhinolaryngol. 2020;129:109773.

    Article  Google Scholar 

  7. Wang LM, Zhu Q, Ma T et al. Value of ultrasonography in diagnosis of pediatric vocal fold paralysis. Int J Pediatr Otorhinolaryngol 2011; 75:1186–1190.

  8. Vats A, Worley GA, de Bruyn R, Porter H, Albert DM, Bailey CM. Laryngeal ultrasound to assess vocal fold paralysis in children. J Laryngol Otol. 2004;118:429–31.

    Article  CAS  Google Scholar 

  9. Sayyid Z, Vendra V, Meister KD, Krawczeski CD, Speiser NJ, Sidell DR. Application-based translaryngeal ultrasound for the assessment of vocal fold mobility in children. Otolaryngol Head Neck Surg. 2019;161:1031–5.

    Article  Google Scholar 

  10. Ongkasuwan J, Ocampo E, Tran B. Laryngeal ultrasound and vocal fold movement in the pediatric cardiovascular intensive care unit. Laryngoscope 2017; 127:167–172. Findings from this study highlight the utility and accuracy of laryngeal ultrasound for vocal fold motion impairment in the pediatric population with decreased hemodynamic change when compared to flexible nasolaryngoscopy.

  11. Ongkasuwan J, Devore D, Hollas S, Jones J, Tran B. Laryngeal ultrasound and pediatric vocal fold nodules. Laryngoscope. 2017;127:676–8.

    Article  Google Scholar 

  12. Lee MGY, Millar J, Rose Eet al. Laryngeal ultrasound detects a high incidence of vocal cord paresis after aortic arch repair in neonates and young children. J Thorac Cardiovasc Surg 2018; 155:2579–2587.

  13. Ongkasuwan J, Tran B. Pediatric Laryngeal ultrasound: vocal fold mobility.

  14. Friedman S, Sadot E, Gut G, Armoni Domany K, Sivan Y. Laryngeal ultrasound for the diagnosis of laryngomalacia in infants. Pediatr Pulmonol. 2018;53:772–7.

    Article  Google Scholar 

  15. Huang H, Xia C, Hu M, Ma T, Zhu Q, Zhao H. The role of laryngeal ultrasound in diagnosis of infant laryngomalacia. Int J Pediatr Otorhinolaryngol. 2019;124:111–5.

    Article  Google Scholar 

  16. Oulego-Erroz I, Terroba-Seara S, Alonso-Quintela P, Benavent-Torres R, Castro-Vecino P, Martinez-Saez de Jubera J. Bedside airway ultrasound in the evaluation of neonatal stridor. J Pediatr 2020.

  17. Lambert EM, Tran HD, Ongkasuwan J. Comparison of endoscopic and ultrasonographic measurements of the subglottic airway in children. Otolaryngol Head Neck Surg. 2020;194599820936249.

  18. Bell JR, Cohen AP, Graff JTet al. Pilot study to assess the use of ultrasound in evaluating the abnormal pediatric airway. Otolaryngol Head Neck Surg 2020; 162:950–953.

  19. Samprathi M, Baranwal AK, Gupta PK, Jayashree M. Pre-extubation ultrasonographic measurement of intracricoid peritubal free space: a pilot study to predict post-extubation airway obstruction in children. Int J Pediatr Otorhinolaryngol. 2020;138:110348.

    Article  Google Scholar 

  20. Loy KA, Lam AS, Otjen JP, Dahl JP. Tracheal cartilaginous sleeve diagnosed on ultrasound in a child with Pfeiffer syndrome. Int J Pediatr Otorhinolaryngol. 2020;138:110321.

    Article  Google Scholar 

  21. Ulualp SO, Szmuk P. Drug-induced sleep endoscopy for upper airway evaluation in children with obstructive sleep apnea. Laryngoscope. 2013;123:292–7.

    Article  Google Scholar 

  22. Raposo D, Menezes M, Rito Jet al. Drug-induced sleep endoscopy in pediatric obstructive sleep apnea. Otolaryngol Head Neck Surg 2020:194599820947666.

  23. He S, Peddireddy NS, Smith DFet al. Outcomes of drug-induced sleep endoscopy-directed surgery for pediatric obstructive sleep apnea. Otolaryngol Head Neck Surg 2018; 158:559–565.

  24. Saniasiaya J, Kulasegarah J. Outcome of drug induced sleep endoscopy directed surgery in paediatrics obstructive sleep apnoea: a systematic review. Int J Pediatr Otorhinolaryngol. 2020;139:110482.

    Article  Google Scholar 

  25. Akkina SR, Ma CC, Kirkham EM, Horn DL, Chen ML, Parikh SR. Does drug induced sleep endoscopy-directed surgery improve polysomnography measures in children with Down syndrome and obstructive sleep apnea? Acta Otolaryngol. 2018;138:1009–13.

    Article  Google Scholar 

  26. Wootten CT, Chinnadurai S, Goudy SL. Beyond adenotonsillectomy: outcomes of sleep endoscopy-directed treatments in pediatric obstructive sleep apnea. Int J Pediatr Otorhinolaryngol. 2014;78:1158–62.

    Article  Google Scholar 

  27. Zalzal HG, Davis K, Carr MM, Coutras S. Epiglottopexy with or without aryepiglottic fold division: comparing outcomes in the treatment of pediatric obstructive sleep apnea. Am J Otolaryngol. 2020;41:102478.

    Article  Google Scholar 

  28. Thorpe RK, Kanotra SP. Pediatric epiglottopexy using an endoscopic suturing device. Laryngoscope 2020.

  29. Oomen KP, Modi VK. Epiglottopexy with and without lingual tonsillectomy. Laryngoscope. 2014;124:1019–22.

    Article  Google Scholar 

  30. Kanotra SP, Givens VB, Keith B. Swallowing outcomes after pediatric epiglottopexy. Eur Arch Otorhinolaryngol. 2020;277:285–91.

    Article  Google Scholar 

  31. Colaianni CA, Bowe SN, Osborn HA, Lin DT, Richmon JD, Hartnick CJ. Robotic epiglottopexy for severe epiglottic prolapse limiting decannulation. Int J Pediatr Otorhinolaryngol. 2017;102:157–9.

    Article  Google Scholar 

  32. McCormick ME. Trends in subglottic stenosis management: resource utilization and pediatric otolaryngology training. Laryngoscope 2020. This study highlights the shift in management of subglottic stenosis from primarily open airway procedures to endoscopic procedures, though the number of pediatric admissions for subglottic stenosis has remained unchanged.

  33. Bogdasarian RS, Olson NR. Posterior glottic laryngeal stenosis. Otolaryngol Head Neck Surg (1979) 1980; 88:765–772.

  34. Thorpe RK, Kanotra SP. Surgical management of bilateral vocal fold paralysis in children: a systematic review and meta-analysis. Otolaryngol Head Neck Surg. 2020;194599820944892.

  35. Ejnell H, Tisell LE. Acute temporary laterofixation for treatment of bilateral vocal cord paralyses after surgery for advanced thyroid carcinoma. World J Surg. 1993;17:277–81.

    Article  CAS  Google Scholar 

  36. Madani S, Bach A, Matievics Vet al. A new solution for neonatal bilateral vocal cord paralysis: endoscopic arytenoid abduction lateropexy. Laryngoscope 2017; 127:1608–1614.

  37. Montague GL, Bly RA, Nadaraja GS, Conrad DE, Parikh SR, Chan DK. Endoscopic percutaneous suture lateralization for neonatal bilateral vocal fold immobility. Int J Pediatr Otorhinolaryngol. 2018;108:120–4.

    Article  Google Scholar 

  38. Puricelli MD, Peterson J. Kanotra SP. Laryngoscope: Ultrasound-guided suture lateralization in pediatric bilateral vocal fold immobility; 2020.

    Google Scholar 

  39. Lee JW, Bon-Mardion N, Smith ME, Marie JP. Bilateral selective laryngeal reinnervation for bilateral vocal fold paralysis in children. JAMA Otolaryngol Head Neck Surg. 2020;146:401–7.

    Article  Google Scholar 

  40. Cotton RT, Seid AB. Management of the extubation problem in the premature child. Anterior cricoid split as an alternative to tracheotomy. Ann Otol Rhinol Laryngol. 1980;89:508–11.

    Article  CAS  Google Scholar 

  41. Sedaghat S, Tapia M, Fredes F, Rojas P. Endoscopic management of bilateral vocal fold paralysis in newborns and infants. Int J Pediatr Otorhinolaryngol. 2017;97:13–7.

    Article  Google Scholar 

  42. Rutter MJ, Hart CK, Alarcon Aet al. Endoscopic anterior-posterior cricoid split for pediatric bilateral vocal fold paralysis. Laryngoscope 2018; 128:257–263. A new technique for managing pediatric bilateral vocal fold paralysis is described in this study, with endoscopic anterior-posterior cricoid split without a graft allowing for successful extubation of the majority of patients in the study without need for tracheostomy.

  43. Mirabile L, Serio PP, Baggi RR, Couloigner VV. Endoscopic anterior cricoid split and balloon dilation in pediatric subglottic stenosis. Int J Pediatr Otorhinolaryngol. 2010;74:1409–14.

    Article  Google Scholar 

  44. Horn DL, Maguire RC, Simons JP, Mehta DK. Endoscopic anterior cricoid split with balloon dilation in infants with failed extubation. Laryngoscope. 2012;122:216–9.

    Article  Google Scholar 

  45. Carr S, Dritsoula A, Thevasagayam R. Endoscopic cricoid split in a tertiary referral paediatric centre. J Laryngol Otol. 2018;132:753–6.

    Article  CAS  Google Scholar 

  46. Inglis AF Jr, Perkins JA, Manning SC, Mouzakes J. Endoscopic posterior cricoid split and rib grafting in 10 children. Laryngoscope. 2003;113:2004–9.

    Article  Google Scholar 

  47. Shah J, Ciolek P, Hopkins B. Novel endoscopic suturing technique to mitigate risk of graft extrusion in endoscopic posterior cricoid split and costal cartilage grafting: a case report. Int J Pediatr Otorhinolaryngol. 2018;109:164–7.

    Article  Google Scholar 

  48. McClay JE, Brewer J, Johnson R. Sutureless vs sutured posterior costal cartilage grafting in laryngotracheal reconstruction in children. Arch Otolaryngol Head Neck Surg. 2011;137:1276–9.

    Article  Google Scholar 

  49. Dahl JP, Purcell PL, Parikh SR, Inglis AF Jr. Endoscopic posterior cricoid split with costal cartilage graft: a fifteen-year experience. Laryngoscope. 2017;127:252–7.

    Article  Google Scholar 

  50. Cohen MD, Weber TR, Rao CC. Balloon dilatation of tracheal and bronchial stenosis. AJR Am J Roentgenol. 1984;142:477–8.

    Article  CAS  Google Scholar 

  51. Achkar J, Dowdal J, Fink D, Franco R, Song P. Balloon dilation complication during the treatment of subglottic stenosis: background of the FDA class 1 recall for the 18 x 40-mm Acclarent Inspira AIR balloon dilation system. Ann Otol Rhinol Laryngol. 2013;122:364–8.

    Article  Google Scholar 

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Correspondence to Nikhila Raol.

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Raol, N., Hartnick, C. Pediatric Airway Surgery: Advances in Evaluation and Endoscopic Management. Curr Otorhinolaryngol Rep 9, 29–36 (2021). https://doi.org/10.1007/s40136-020-00325-3

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