Endoscopic Anteroposterior Cricoid Split in Idiopathic Bilateral Vocal Fold Immobility in Newborns: A Consecutive Case Series.

Abstract

The objective of this study was to evaluate the efficacy of endoscopic anteroposterior cricoid split (APCS) in the management of congenital idiopathic bilateral vocal fold immobility (ciBVFI). In this retrospective monocentric study, all patients who underwent APCS for ciBVFI between January 2017 and December 2022 were included. APCS was indicated in case of failure to wean off non-invasive ventilation (NIV) or in cases requiring intubation. Surgical success was defined as the absence of tracheotomy or laryngoplasty at the end of follow-up, as well as a satisfactory respiratory status without exertional dyspnea over a minimum follow-up period of 18 months post surgery. Sixteen children, including 11 boys (69%), were included. The mean follow-up period was 52.4 ± 22.0 months. The mean age at APCS was 1.7 ± 1.9 months. Among the seven children of the success group (44%), all (7/7, 100%) regained vocal fold mobility. The mean recovery time was 12 ± 11 months (p = 0.003). In the failure group (n = 9), eight patients (89%) underwent tracheotomy at the age of 3.8 ± 4.6 months. The balloon dilatation diameter was statistically different between the successful and failure groups (p = 0.003). The outer diameter of the stenting intubation tube, duration of postoperative intubation, and performance of follow-up endoscopies were not significantly different. APCS is a straightforward technique that has a role to play in the surgical treatment of ciBVFI. It enables a watchful waiting approach to allow spontaneous recovery of vocal fold mobility, thus avoiding invasive procedures such as early tracheostomy or laryngoplasty.