NDLI: Vocal cord paralysis and Dysphagia after aortic arch reconstruction and Norwood procedure.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Pham, Vinh Connelly, Diana Wei, Julie L. Sykes, Kevin J. O'Brien, Jim
Description	Country affiliation: United States Author Affiliation: Pham V ( University of Kansas School of Medicine, Kansas City, Kansas, USA.)
Abstract	OBJECTIVES: To determine the incidence of vocal cord (VC) paralysis and dysphagia after aortic arch reconstruction, including the Norwood procedure. SETTING: Tertiary children's hospital. STUDY DESIGN: Retrospective cohort. METHODS: Database/chart review of neonates requiring Norwood or arch surgery between January 2005 and December 2012. Demographics, postoperative VC function, dysphagia, need for gastrostomy tube and/or tracheotomy, and long-term follow-up were reviewed. RESULTS: One hundred fifty-one consecutive subjects (96 Norwood, 55 aortic arch) were reviewed. Median age at repair was 9 days (interquartile range [IQR], 7-13) for Norwood and 24 days (IQR, 12-49) for arch reconstruction (P < .001). Documentation of VC motion abnormality was found in 60 of 104 (57.6%) subjects and unavailable in 47 (16 without documentation and 31 who died prior to extubation). There were no significant differences in proportions of documented VC motion (P = .337), dysphagia (P = .987), and VC paralysis (P = .706) between the arch and Norwood groups. Dysphagia was found in 73.5% of Norwood and 69.2% of arch subjects who had documented VC paralysis. Even without unilateral VC paralysis (UVCP), dysphagia was present (56% Norwood, 61% arch). Overall, 120 of 151 (79.5%) required feeding evaluation and a modified feeding regimen. Gastrostomy was required in 31% of Norwood and 23.6% of arch reconstruction overall. To date, mortality in this series is 55 of 151 (36.4%) patients. Of those with VC paralysis, only 23 (22%) had any otolaryngology follow-up after discharge from surgery. More than 75% with VC paralysis with follow-up after hospital discharge had persistent VC paralysis 11.5 months after diagnosis. CONCLUSION: There is high incidence of UVCP and dysphagia after Norwood and arch reconstruction. Dysphagia was highly prevalent in both groups even without UVCP. Preoperative discussion on vocal cord function and dysphagia should be considered.
File Format	HTM / HTML
ISSN	01945998
e-ISSN	10976817
DOI	10.1177/0194599814522413
Journal	Otolaryngology -- Head and Neck Surgery
Issue Number	5
Volume Number	150
Language	English
Publisher	SAGE Publications
Publisher Date	2014-05-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Gastrostomy Discipline Otolaryngology Aorta, Thoracic Norwood Procedures Deglutition Disorders Etiology Surgery Tracheostomy Vocal Cord Paralysis Retrospective Studies Nutritional Support Postoperative Complications Reconstructive Surgical Procedures Infant, Newborn
Content Type	Text
Resource Type	Article
Subject	Otorhinolaryngology Surgery

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