Abstract | OBJECTIVES: To improve the recognition of differences in presentation amongst patients with type 1 laryngeal clefts of various ages and better understand the age dependent outcomes of injection laryngoplasty. A second aim was to analyze the discrepancies between swallow assessment modalities in various age groups with type I laryngeal clefts undergoing injection laryngoplasty. METHODS: A retrospective review of electronic medical records of patients who underwent injection laryngoplasty from 2009 through 2015 at a tertiary care children's hospital. Data extracted included: Demographics, histories and physical exam findings, diagnostic studies, and medical and surgical treatments. RESULTS: Most (72/102, 70.6%) patients were male with a median gestational age at birth of 37 weeks (range 24-41 weeks). Formula thickening and GERD medications were used in 94/102 (92.2%) and 97/102 (95.1%) patients, respectively. Comorbid GERD, laryngomalacia, tracheomalacia, and subglottic stenosis were present in 98/102 (96.1%), 40/102 (39.2%), 9/102 (8.8%), and 14/102 (13.7%) patients, respectively. There was no significant difference in demographics, comorbidities or medical therapy between age groups. Symptoms at presentation differed between age groups with stridor (χ2(1) = 11.6, p = 0.002) and cyanosis (χ2(1) = 8.13, p = 0.012) being more common in the 0-3-month group compared to the 12-36 month group. Symptom resolution and the odds of undergoing additional surgery (second injection or suture repair) over time, however, did not differ. There was a significant reduction in aspiration with thins during FEES (McNemar χ2(1) = 10.7, p = 0.002) and aspiration with nectar during MBS (McNemar χ2(1) = 5.26, p = 0.035) post-injection. After injection, there was significant agreement in aspiration with thins between FEES and MBS (kappa = 0.308 ± SE 0.170, p = 0.035). However, finding aspiration with thins was more common during MBS than during FEES (McNemar χ2(1) = 7.00, p = 0.016). There were no differences in swallow evaluation findings between the age groups. CONCLUSIONS: Symptoms of type I laryngeal clefts may differ by age. However, there was no impact of age on the safety and efficacy of surgical intervention.
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Authors | Elisabeth Cole, Alexandra Dreyzin, Amber D Shaffer, Allison B J Tobey, David H Chi, Tony Tarchichi |
Journal | International journal of pediatric otorhinolaryngology
(Int J Pediatr Otorhinolaryngol)
Vol. 115
Pg. 10-18
(Dec 2018)
ISSN: 1872-8464 [Electronic] Ireland |
PMID | 30368367
(Publication Type: Journal Article)
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Copyright | Copyright © 2018 Elsevier B.V. All rights reserved. |
Chemical References |
- Contrast Media
- Barium Sulfate
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Topics |
- Age Factors
- Barium Sulfate
- Child, Preschool
- Congenital Abnormalities
(physiopathology, surgery)
- Contrast Media
- Deglutition
- Deglutition Disorders
(diagnostic imaging, etiology, surgery)
- Endoscopy, Gastrointestinal
- Female
- Humans
- Infant
- Infant, Newborn
- Injections
- Laryngoplasty
(methods)
- Larynx
(abnormalities, physiopathology, surgery)
- Male
- Reoperation
- Respiratory Aspiration
(etiology)
- Retrospective Studies
- Treatment Outcome
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