Analysis Of Therapeutic Effect Of Lateral Cordopexy For Neonatal Bilateral Vocal Cord Paralysis

Objective:To evaluate the clinical effectiveness and feasibility of endoscopic percutaneous lateral cordopexy for bilateral vocal cord paralysis in neonates,we compared the postoperative conditions of the patients who received lateral cordopexy and tracheotomy.Methods:A retrospective analysis was conducted on neonates with bilateral vocal cord paralysis who underwent lateral cordopexy and tracheotomy in the Department of Otolaryngology of our hospital from 2015 to 2019.A total of 10 complete cases met the inclusion criteria,including 8 males and 2 females.The patients were followed up for 1 year.All the children developed stridor and dyspnea immediately after birth,and were diagnosed as bilateral vocal cord paralysis,required immediate respiratory support.According to the operation mode,they were divided into two groups:the experimental group underwent lateral cordopexy(4 cases);the control group underwent tracheotomy(6 cases).The two groups were analyzed for statistical differences in improving respiration,growth and development,family quality of life,family medical expenses in the first year after surgery,and other postoperative complicationsResults:The patients were followed up for 1 year after surgery1.Respiration:Dyspnea of 6 patients in the tracheotomy group was relieved.In the lateral cordopexy group,3 cases of dyspnea were resolved,and another case had to be performed tracheotomy because his breathing was not improved.There was no statistically significant difference in respiratory improvement between the two groups((P>0.05)2.Family quality of life impact:Data from the first year after surgery showed a statistically significant overall effect on family quality of life after surgery in both groups(P<0.05).The effect of lateral cordopexy on postoperative family quality of life is less than that of tracheotomy.3.Postoperative growth and development:There was no statistical significance in the mean weight gain between the two groups(P>0.05).There,there was no difference between suture lateralization and tracheotomy in the growth and development.4.Family medical expenses in the first year after surgery;The mean family medical expenses in the first year after surgery was statistically significant between the two groups(P>0.05).The cost to families in the first year after lateral cordopexy is generally less than that of tracheotomy.5.Other postoperative conditions:Both groups of patients were changed to oral feeding after sugery.In the first year after operation,the voice condition improved or had no change compared with that before operation,and no aggravation of postoperative hoarseness occurred.Occasionally pneumonia occurred in 3 children with successful lateral cordopexy.In the tracheotomy group,6 patients developed recurrent pneumonia,which was caused by tracheostomy infection;four children showed incision granulation tissue;cannula obstruction occurred in 2 cases;1 case had dislocation of the cannula.Conclusions:1.Clinical effectiveness:Endoscopic lateral cordopexy may be a minimally invasive,effective and reversible surgical method without special instruments.It can solve the dyspnea of most children,to achieve the purpose of treatment,and avoid all postoperative problems associated with tracheotomy.2.Clinical feasibility:Lateral cordopexy may be a preferred procedure before tracheotomy.If ineffective,tracheostorny was considered.