Structure and Function of the Vocal Cords after Airway Reconstruction on Magnetic Resonance Imaging

Bernadette B.L.J. Elders, Marieke M. Hakkesteegt, Pierluigi Ciet, Harm A.W.M. Tiddens, Piotr Wielopolski, Bas Pullens*

*Corresponding author for this work

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Abstract

Objectives/Hypothesis: Dysphonia is a common problem at long-term follow-up after airway surgery for laryngotracheal stenosis (LTS) with major impact on quality of life. Dysphonia after LTS can be caused by scar tissue from initial stenosis along with anatomical alterations after surgery. There is need for a modality to noninvasively image structure and function of the reconstructed upper airways including the vocal cords to assess voice outcome and possible treatment after LTS. Our objective was to correlate vocal cord structure and function of patients after airway reconstruction for LTS on static and dynamic magnetic resonance imaging (MRI) to voice outcome. Study Design: Prospective cohort study. Methods: Voice outcome was assessed by voice questionnaires ((pediatric) Voice Handicap Index (p)VHI)) and the Dysphonia Severity Index (DSI). Postsurgical anatomy, airway lumen, and vocal cord thickness and movement on multiplanar static high-resolution MRI and dynamic acquisitions during phonation was correlated to voice outcome. Results: Forty-eight patients (age 14.4 (range 7.5–30.7) years) and 11 healthy volunteers (15.9 (8.2–28.8) years) were included. Static MRI demonstrated vocal cord thickening in 80.9% of patients, correlated to a decrease in DSI (expected odds 0.75 [C.I. 0.58–0.96] P =.02). Dynamic MRI showed impaired vocal cord adduction during phonation in 61.7% of patients, associated with a lower DSI score (0.65 [C.I. 0.48–0.88] P =.006). Conclusions: In LTS patients, after airway reconstruction MRI can safely provide excellent structural and functional detail of the vocal cords correlating to DSI, with further usefulness expected from technical refinements. We therefore suggest MRI as a tool for extensive imaging during LTS follow-up. Level of evidence: 3 Laryngoscope, 131:E2402–E2408, 2021.

Original languageEnglish
Pages (from-to)E2402-E2408
JournalLaryngoscope
Volume131
Issue number7
DOIs
Publication statusPublished - 18 Jan 2021

Bibliographical note

Acknowledgments:
The authors would like to acknowledge Eleni Rosalina Andrinopoulou for the statistical support on the article and Wytse van den Bosch for his help with the interobserver analysis.

Publisher Copyright:
© 2021 The Authors. The Laryngoscope published by Wiley Periodicals LLC. on behalf of The American Laryngological, Rhinological and Otological Society, Inc.

Research programs

  • EMC OR-01-54-02

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