Surgical Interventions for Pediatric Unilateral Vocal XXXX : A Systematic Review.

@entity1 @entity7364 @entity736 @entity912 @entity1173
Importance: The most widely used surgical interventions for pediatric unilateral vocal @entity912 include injection laryngoplasty, thyroplasty, and laryngeal reinnervation. Despite increasing interest in surgical interventions for unilateral vocal @entity912 in @entity1 , the surgical outcomes data in @entity1 are scarce. Objective: To appraise and summarize the available evidence for pediatric unilateral vocal @entity912 surgical strategies. Evidence Review: MEDLINE (1946-2014) and EMBASE (1980-2014) were searched for publications that described the results of laryngoplasty, thyroplasty, or laryngeal reinnervation for pediatric unilateral vocal @entity912 . Further studies were identified from bibliographies of relevant studies, gray literature, and annual scientific assemblies. Two reviewers independently appraised the selected studies for quality, level of evidence, and risk of bias as well as extracted data, including unilateral vocal @entity912 origin, voice outcomes, swallowing outcomes, and adverse events. Findings: Of 366 identified studies, the inclusion criteria were met by 15 studies: 6 observational studies, 6 case series, and 3 case reports. All 36 @entity1 undergoing laryngeal reinnervation (8 studies) had improvement or resolution of @entity7364 . Of 31 @entity1 receiving injection laryngoplasty (6 studies), most experienced improvement in voice quality, speech, swallowing, @entity1173 , and glottic closure. Of 12 @entity1 treated by thyroplasty (5 studies), 2 experienced resolution of @entity7364 , 4 had some improvement, and 4 had no improvement (2 @entity1 had undocumented outcomes). Thyroplasty resolved or improved @entity1173 in 7 of 8 @entity1 . Conclusions and Relevance: Published studies suggest that reinnervation may be the most effective surgical intervention for @entity1 with @entity7364 ; however, long-term follow-up data are lacking. With the exception of @entity736 injections, injection laryngoplasty was reported to be a relatively safe, nonpermanent, and effective option for most @entity1 with @entity7364 . Thyroplasty appears to have fallen out favor in recent years because of difficulty in performing this procedure in @entity1 under local anesthesia, but it continues to be a viable option for @entity1 with @entity1173 .
