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An evaluation of arytenoid prolapse following laryngotracheal reconstruction
Author(s) -
Li Lilun,
Black Kaelan,
White Michelle,
Zalzal George,
Preciado Diego
Publication year - 2020
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27864
Subject(s) - medicine , arytenoid cartilage , laryngotracheal stenosis , surgery , incidence (geometry) , retrospective cohort study , airway obstruction , stenosis , airway , larynx , tracheal stenosis , radiology , physics , optics
Objectives/Hypothesis Laryngotracheal reconstruction (LTR) is a collection of procedures used to tr e at pediatric laryngotracheal stenosis. Arytenoid prolapse is a potential postoperative complication that may lead to upper airway obstruction. This study investigates the incidence, risk factors, and need for surgical intervention for post‐LTR arytenoid prolapse. Study Design Retrospective chart review. Methods The charts of 107 patients who underwent a total of 119 LTR procedures between 2005 and 2018 at a tertiary free‐standing children's hospital were reviewed. Results The incidence of post‐LTR arytenoid prolapse was 7.6%. Age, glottic involvement, tracheostomy status, vocal cord paralysis, and balloon dilation had no effect on arytenoid prolapse development. Sixteen percent of procedures performed in children <8 kg resulted in arytenoid prolapse, versus 4.5% of procedures performed in children >8 kg ( P = .036). One hundred percent 100% of patients with post‐LTR arytenoid prolapse had placement of a posterior graft. Multivariate analysis confirmed both weight <8 kg and posterior graft use to be significantly associated with arytenoid prolapse ( P = .027 and .039, respectively). Three of the nine patients with arytenoid prolapse were symptomatic and weighed <8 kg at time of surgery. One required voice therapy; two required surgical intervention. Conclusions The incidence of arytenoid prolapse is 7.6% following LTR. Patients undergoing posterior graft LTR or weigh <8 kg at time of surgery are more likely to develop arytenoid prolapse. Children <8 kg at time of surgery who develop arytenoid prolapse are more likely to be symptomatic and require further intervention. These findings are valuable for preoperative risk assessment of pediatric laryngotracheal stenosis management. Level of Evidence 4 Laryngoscope , 130:247–251, 2020