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Routine vocal cord mobility assessment post cardiac surgery via median sternotomy approach
- Source :
- International Journal of Pediatric Otorhinolaryngology. 138:110331
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Surgery of the aortic arch carries a risk of injury to the vagus and recurrent laryngeal nerves, particularly in a young child, as these structures lie in close proximity to aortic arch. This study aimed to determine the incidence, symptomatology and natural history of vocal cord dysfunction (VCD) following aortic arch reconstructive surgery through a median sternotomy approach.Prospective assessment was performed of all consecutive newborns who underwent cardiac surgery for aortic arch surgery via median sternotomy between January 2016 and May 2017 at a tertiary paediatric hospital. All patients underwent post-operative flexible fibreoptic nasolaryngoscopy (FNL) after extubation to assess for the presence of vocal cord dysfunction (VCD). Those with VCD were re-examined at followup. A feeding assessment performed by speech pathologists (SPs) and a video fluoroscopic swallow study (VFSS) were also performed in those with VCD or feeding difficulties.A total of 35 newborns were included in the study. At initial review, left sided VCD was demonstrated in 65.7% of patients (n=23). Significant associations with VCD were younger age (3.0 versus 6.5 days, p=0.041) and a weak or absent cry (Relative Risk=16.4, 95%CI 3.8-47.8, p0.001). 52.5% (n=11) of patients with VCD had evidence of aspiration on VFSS. There was no significant difference in intensive care unit stay or overall hospital stay between patients with VCD compared to those without (33.0 days vs 28.8 days, p=0.73; 52.5 vs 45.9, p=0.72.) Infants with either proven VCD or a weak cry were more likely to be discharged home with a nasogastric (NG) tube (RR=4.67, p= 0.048; RR=7.00 p=0.022 respectively). At followup after 106 days, complete resolution was seen in 100% patients with partial VCD and 61.5% with complete VCD.VCD is a common complication following neonatal aortic arch surgery, although most experience resolution of symptoms over time. The authors recommend post-operative laryngoscopy in all patients should be routine, and particularly those with a weak cry.
- Subjects :
- Aortic arch
endocrine system
medicine.medical_specialty
Reconstructive surgery
Cord
medicine.medical_treatment
Laryngoscopy
Vocal Cords
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
030225 pediatrics
medicine.artery
medicine
Vocal cord dysfunction
Humans
Prospective Studies
Cardiac Surgical Procedures
Child
030223 otorhinolaryngology
medicine.diagnostic_test
business.industry
Infant, Newborn
Infant
General Medicine
medicine.disease
Sternotomy
Cardiac surgery
Surgery
Otorhinolaryngology
Median sternotomy
Pediatrics, Perinatology and Child Health
business
Complication
Vocal Cord Paralysis
Subjects
Details
- ISSN :
- 01655876
- Volume :
- 138
- Database :
- OpenAIRE
- Journal :
- International Journal of Pediatric Otorhinolaryngology
- Accession number :
- edsair.doi.dedup.....1988d457df0e35efead1d15e4e7b4abc