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

• Published in: The Laryngoscope Vol. 131; no. 7; pp. E2402 - E2408
• Main Authors: Elders, Bernadette B. L. J., Hakkesteegt, Marieke M., Ciet, Pierluigi, Tiddens, Harm A. W. M., Wielopolski, Piotr, Pullens, Bas
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.07.2021
• Subjects: dysphonia; laryngotracheal stenosis; magnetic resonance imaging; Pediatrics; voice; voice; Pediatrics; magnetic resonance imaging; laryngotracheal stenosis; dysphonia
• ISSN: 0023-852X; 1531-4995
• DOI: 10.1002/lary.29399

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