Endoscopic Perctaneous Suture Laterlization for Neonatal BVFP

This instructional video details the steps of endoscopic percutaneous suture lateralization for neonatal bilateral vocal fold paralysis. Conducted under general anesthesia, the procedure begins with laryngeal suspension using a Parsons laryngoscope size 8 and examination with a 4mm telescope. After assessing joint mobility, precise neck preparation precedes needle insertion. Utilizing an 18-gauge needle threaded with 4.0 proline as a single thread, it is inserted below the right true vocal cord, anterior to the vocal process of the arytenoid, and pulled using crocodile forceps. Subsequently, a 21-gauge needle threaded with 4.0 proline as a loop thread is inserted above the vocal cord, with the distal thread pulled through the loop. Following needle removal, a 7 mm horizontal neck incision is made for tissue dissection. Suture is meticulously tied over a silastic sheet under endoscopic guidance, ensuring optimal vocal cord lateralization. This comprehensive video offers valuable insights into this delicate surgical intervention.

Pediatric bilateral vocal fold paralysis.

Difficult laryngeal exposure. Not fit for general anesthesia.

Neonatal and pediatric laryngoscope and laryngeal telescope. Vocal fold retractor. Neonatal micro-laryngeal set.

Pediatric laryngoscopy with suspension. Spontaneous breathing aided by side port insufflation.

Routine preoperative work up of bilateral vocal fold immobility.

Alternate procedures for neonate bilateral vocal fold paralysis include endoscopic anterior and posterior cricoid split, and tracheostomy.

Laryngeal edema and injury to vocal fold or surrounding structures.

No disclosure.

Montague GL, Bly RA, Nadaraja GS, Conrad DE, Parikh SR, Chan DK. Endoscopic percutaneous suture lateralization for neonatal bilateral vocal fold immobility. Int J Pediatr Otorhinolaryngol. 2018 May;108:120-124. doi: 10.1016/j.ijporl.2018.02.032. Epub 2018 Mar 21. PMID: 29605340.