Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2022, Vol. 36 ›› Issue (1): 95-99.doi: 10.6040/j.issn.1673-3770.0.2021.259

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Application of laryngeal microsurgery in severe neonatal upper airway obstruction

ZENG Bin1, LÜ Dan1, REN Jia1, HU Juanjuan1, YU Lingyu1, LU Huan2, YANG Hui1   

  1. 1. Department of Otorhinolaryngology & Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China;
    2. Department of Otorhinolaryngology & Head and Neck Surgery, Chengdu Wuhou Likang Hospital, Chengdu 610041, Sichuan, China
  • Published:2022-02-22

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Abstract: Objective The aim of this study was to explore the etiology, clinical features, and the microsurgery efficacy of severe neonatal upper airway obstruction, to achieve better diagnosis and treatment of neonatal obstructive dyspnea. Methods An observative research was conducted enrolling 16 neonates with severe throat-related upper airway obstruction. Results A total of 16 neonates(9 males and 7 females)were registered, whose clinical symptoms appeared 7-28 days after birth and included inspiratory dyspnea, stridor, and the three-concave sign. Patients were classified as follows: 6 cases of congenital laryngomalacia; 3 hypopharynx and tongue root cysts; 2 laryngeal hemangiomas; 1 laryngeal entrance teratoma; 1 congenital laryngeal webbing; 1 bilateral vocal cord paralysis; 1 secondary subglottic stricture; 1 laryngeal adhesion after intubation. All 16 neonates were treated with appropriate microsurgery, and all operations went smoothly. Altogether, 15 neonates were extubated smoothly, except for 1 case of laryngomalacia in which a tracheotomy was performed. Conclusion Severe neonatal upper airway obstruction is mostly frequently related to laryngopharynx lesions. Early local and systemic examinations are required to confirm the cause and diagnosis. Timely minimally invasive surgery for patients with surgical indications can achieve satisfactory results and save their lives.

Key words: Neonatal, Laryngeal obstruction, Upper airway obstruction, Laryngeal microsurgery, Treatment

CLC Number: 

  • R767.13
[1] 王华, 王桂香, 赵靖, 等. 新生儿上气道梗阻的临床评估和相关干预[J]. 临床耳鼻咽喉头颈外科杂志, 2019,33(12): 1153-1157. doi:10.13201/j.issn.1001-1781.2019.12.009. WANG Hua, WANG Guixiang, ZHAO Jing, et al. Clinical assessment and related intervention of neonatal upper airway obstruction[J]. J Clin Otorhinolaryngol Head Neck Surg, 2019,33(12): 1153-1157. doi:10.13201/j.issn.1001-1781.2019.12.009.
[2] Carter J, Rahbar R, Brigger M, et al. International Pediatric ORL Group(IPOG)laryngomalacia consensus recommendations[J]. Int J Pediatr Otorhinolaryngol, 2016, 86(7): 256-61. doi: 10.1016/j.ijporl.2016.04.007.
[3] 张勤, 王腾飞, 陈永宁, 等. 新生儿头颈部占位40例分析[J]. 中华耳鼻咽喉头颈外科杂志, 2021, 56(5): 459-464. doi: 10.3760/cma.j.cn115330-20201027-00835. ZHANG Qin, WANG Tegnfei, CHEN Yongning, et al. Clinical analysis of 40 newborns with head and neck occupying lesions Clinical analysis of 40 newborns with head and neck occupying lesions[J]. Clinical analysis of 40 newborns with head and neck occupying lesions, 2021, 56(5): 459-464. doi: 10.3760/cma.j.cn115330-20201027-00835.
[4] Bluher AE, Darrow DH. Stridor in the Newborn[J]. Pediatr Clin North Am, 2019, 66(2):475-488. doi: 10.1016/j.pcl.2018.12.013.
[5] 潘宏光, 严尚, 李兰, 等. 支撑喉镜内镜下经皮声带外移缝合固定术治疗新生儿双侧声带麻痹[J]. 中华耳鼻咽喉头颈外科杂志, 2020, 55(2): 165-168. doi: 10.3760/cma.j.issn.1673-0860.2020.02.016. PAN Hongguang, YAN Shang, LI Lan, et al. Endoscopic percutaneous suture lateralization for neonatal bilateral vocal cord paralysis[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2020, 55(2): 165-168. doi: 10.3760/cma.j.issn.1673-0860.2020.02.016.
[6] 唐小晶, 黄文娣, 王义, 等. 新生儿先天性舌根囊肿35例分析[J]. 中华围产医学杂志, 2021, 24(1): 49-53. doi: 10.3760/cma.j.cn113903-20200725-00698. TANG Xiaojing, HUANG Wendi, WANG Yi, et al. Neonatal congenital tongue base cyst: clinical analysis of 35 cases[J]. Chinese Journal of Perinatal Medicine, 2021, 24(1): 49-53. doi: 10.3760/cma.j.cn113903-20200725-00698.
[7] Clark CM, Kugler K, Carr MM. Common causes of congenital stridor in infants[J]. JAAPA, 2018, 31(11): 36-40. doi: 10.1097/01.JAA.0000546480.64441.af.
[8] Cohen SR. Congenital glottic webs in children[J]. Ann Otol Rhinol Laryngol, 1985, 94(6_suppl): 2-16. doi:10.1177/00034894850940s601.
[9] Xu HM, Chen F, Zheng YY, et al. Efficacy and toxicities of low-temperature plasma radiofrequency ablation for the treatment of laryngomalacia in neonates and infants: a prospective randomized controlled trial[J]. Ann Transl Med, 2020, 8(21): 1366. doi:10.21037/atm-20-3164.
[10] Vijayasekaran S. Pediatric airway pathology[J]. Front Pediatr, 2020, 8: 246. doi:10.3389/fped.2020.00246.
[11] 陈良嗣, 樊孟耘, 付勇, 等. 儿童喉软化症诊断与治疗临床实践指南[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(11): 961-965. doi:10.13201/j.issn.2096-7993.2020.11.001. CHEN Liangsi, FAN Mengyun, FU Yong, et al. Clinical practice guidelines for the diagnosis and management of laryngomalacia in children[J]. J Clin Otorhinolaryngol Head Neck Surg, 2020, 34(11): 961-965. doi:10.13201/j.issn.2096-7993.2020.11.001.
[12] 彭操, 陈秀文, 赵丽萍. 国外家庭参与式综合管理在NICU中的应用现状及对我国的启示[J]. 护理管理杂志, 2019,19(1): 16-20. doi: 10.3969/j.issn.1671-315x.2019.01.004. PENG Cao, CHEN Xiuwen, ZHAO Liping. Application of family integrated care in neonatal intensive care unit overseas and its enlightment for China[J]. J Nurs Adm, 2019,19(1): 16-20. doi: 10.3969/j.issn.1671-315x.2019.01.004.
[13] 黄晓芳, 冯琪. 2019版欧洲新生儿呼吸窘迫综合征防治指南更新要点[J]. 中华新生儿科杂志(中英文), 2019, 34(4): 310-315. doi: 10.3760/cma.j.issn.2096-2932.2019.04.016.
[14] 马娟, 唐仕芳, 陈龙, 等. 2019版欧洲呼吸窘迫综合征管理指南更新要点解读[J]. 重庆医学, 2020,49(1): 1-6. doi: 10.3969/j.issn.1671-8348.2020.01.001. MA Juan, TANG Shifang, CHEN Long, et al. Interpretation of the updated guidelines for the management of European respiratory distress syndrome 2019[J]. Chongqing Med, 2020, 49(1): 1-6. doi: 10.3969/j.issn.1671-8348.2020.01.001.
[15] 宋涛, 沈杰, 蔡惠凤. 保温干预对新生儿腹部手术围术期体温的影响分析[J]. 实用临床护理学电子杂志, 2017, 2(41): 8-9,11. doi: CNKI:SUN:SLHL.0.2017-41-007. SONG Tao, SHEN Jie, CAI Huifeng. Impact analysis insulation intervention to abdominal surgery perioperative body temperature to the newborn[J]. J Clin Nursing's Pract, 2017, 2(41): 8-9,11. doi: CNKI:SUN:SLHL.0.2017-41-007.
[16] 史泽瑶, 吴杨, 李小文, 等. ERAS协会《新生儿肠道手术围术期管理共识指南》解读[J]. 中国全科医学, 2021, 24(11): 1333-1338. doi: 10.12114/j.issn.1007-9572.2021.00.424. SHI Zeyao, WU Yang, LI Xiaowen, et al. Interpretation of consensus guidelines for perioperative care in neonatal intestinal surgery: enhanced recovery after surgery(ERAS)society recommendations[J]. Chin Gen Pract, 2021, 24(11): 1333-1338. doi: 10.12114/j.issn.1007-9572.2021.00.424.
[17] Cohen O, Picard E, Joseph L, et al. Supraglottoplasty for severe laryngomalacia. can we predict success?[J]. Int J Pediatr Otorhinolaryngol, 2020, 11(138):110333. doi: 10.1016/j.ijporl.2020.110333.
[18] 王桂香, 张杰, 赵靖, 等. 婴幼儿舌根囊肿的诊断及围手术期治疗要点[J]. 山东大学耳鼻喉眼学报, 2015, 29(3): 62-64. doi: 10.6040/j.issn.1673-3770.0.2015.004. WANG Guixiang, ZHANG Jie, ZHAO Jing, et al. Diagnosis and perioperative treatment of tongue base cyst in infants[J]. J Otolaryngol Ophthalmol Shandong Univ, 2015, 29(3): 62-64. doi: 10.6040/j.issn.1673-3770.0.2015.004.
[19] Bedwell J, Zalzal G. Laryngomalacia[J]. Seminars in Pediatric Surgery, 2016, 25(3): 119-122. doi: 10.1053/j.sempedsurg.2016.02.004.
[20] Thorne MC, Garetz SL. Laryngomalacia: review and summary of current clinical practice in 2015[J]. Paediatr Respir Rev, 2016, 17: 3-8. doi:10.1016/j.prrv.2015.02.002.
[21] 郑美君, 杨慧, 胡娟娟. 喉显微外科治疗声门型喉蹼的研究进展[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 144-147. doi: 10.6040/j.issn.1673-3770.0.2018.388. ZHENG Meijun, YANG Hui, HU Juanjuan. Advances in phonomicrosurgery for glottic webs[J]. J Otolaryngol Ophthalmol Shandong Univ, 2019,33(5): 144-147. doi: 10.6040/j.issn.1673-3770.0.2018.388.
[22] Madani S, Bach Á, Matievics V, et al. A new solution for neonatal bilateral vocal cord paralysis: Endoscopic arytenoid abduction lateropexy[J]. Laryngoscope, 2017, 127(7): 1608-1614. doi:10.1002/lary.26366.
[23] Chen EY, Inglis AF Jr. Bilateral vocal cord paralysis in children[J]. Otolaryngol Clin North Am, 2008, 41(5): 889-901,viii. doi:10.1016/j.otc.2008.04.003.
[24] 姜集聪, 吴建洺, 高宇. 普萘洛尔治疗婴儿血管瘤的研究进展[J]. 中华皮肤科杂志, 2020, 53(7): 573-576. doi: 10.35541/cjd.20191042. JINAG Jicong, WU Jianming, GAO Yu. Propranolol for the treatment of infantile hemangioma[J]. Chinese Journal of Dermatology, 2020, 53(7): 573-576. doi: 10.35541/cjd.20191042.
[25] Chen ZY, Wang QN, Zhu YH, et al. Progress in the treatment of infantile hemangioma[J]. Ann Transl Med, 2019, 7(22): 692. doi:10.21037/atm.2019.10.47.
[26] Hagen R, Ghareeb E, Jalali O, et al. Infantile hemangiomas: what have we learned from propranolol?[J]. Curr Opin Pediatr, 2018, 30(4): 499-504. doi:10.1097/MOP.0000000000000650.
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