Endoscopic posterior cordotomy for treatment of dyspnea due to vocal fold immobility
| Autor: | Anat Wengier, Anton Warshavsky, Yael Oestreicher-Kedem, Oren Cavel, Oshri Wasserzug, Gilad Horowitz, Max Chason, Barak Ringel, Narin N. Carmel-Neiderman |
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| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty medicine.medical_treatment posterior cordotomy tracheostomy Aspiration pneumonia 03 medical and health sciences 0302 clinical medicine Vocal fold immobility Epidemiology Medicine Original Research Article 030223 otorhinolaryngology Cordotomy Respiratory distress business.industry Medical record Retrospective cohort study dyspnea medicine.disease Dysphagia Surgery 030220 oncology & carcinogenesis Etiology medicine.symptom business |
| Zdroj: | Multidisciplinary Respiratory Medicine |
| ISSN: | 1828-695X |
| Popis: | Introduction: Several surgical procedures have been described for the treatment of respiratory distress secondary to vocal fold immobility (VFI), but the contribution of posterior cordotomy (PC) to tracheostomy weaning or prevention has not been studied in depth, particularly in the acute setting. The objective of this study was to show the effectiveness of PC to relieve dyspnea, prevent the need for tracheostomy, and enable decannulation in patients with VFI. Methods: We conducted a retrospective study and reviewed the medical records of all patients whose dyspnea warranted surgical intervention from January 2013 to January 2018. Data were retrieved on epidemiology, etiology, and duration of VFI, tracheostomy dependence, success in decannulation from tracheostomy or respiratory relief, number of procedures until decannulation, and complications. Results: Twelve suitable patients were identified of whom eleven had bilateral VFI and one had unilateral VFI. Five were tracheostomy-dependent. Ten patients underwent unilateral PC, and two patients underwent bilateral PC. All the patients experienced respiratory relief, eleven after a single PC and one after two PCs. All tracheostomy-dependent patients were decannulated. The mean follow-up after PC was 24.55 months during which none of the patients required a re-tracheostomy and three patients required revision of the PC. There were no surgical complications. Postoperatively, eight patients (67%) experienced a breathy voice and three patients (25%) had dysphagia for fluids. No patient had aspiration pneumonia. Conclusions: We conclude that PC is an easy, safe, and effective procedure for tracheostomy weaning and respiratory relief in patients with VFI. A revision PC may be indicated in some patients. A breathy voice is to be expected, and a few patients will experience dysphagia to fluids that may be addressed by instructing the patient to use a fluid thickener and take small sips. |
| Databáze: | OpenAIRE |
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