Injection of Botulinum Toxin into External Laryngeal Muscles in Pediatric Laryngeal Paralysis
Bibliographic record
Abstract
OBJECTIVES: I undertook to demonstrate the effect of injecting botulinum toxin type A (BTA) into cricothyroid, sternothyroid, and sternohyoid muscles in cases of bilateral laryngeal paralysis (BLP). Tracheostomy remains the consistently reproducible and accepted method to salvage the airway obstruction in BLP. The bypass, however, acknowledges the current lack of knowledge and consensus on the pathogenesis. METHODS: I performed a retrospective chart review of BLP cases treated with BTA in a tertiary care pediatric center. The injections were performed under direct vision through an open transcervical approach. The main outcome measures used were improvement of airway symptoms and endoscopic findings, tracheostomy requirement, and incidence of recovery of function. RESULTS: In total, 24 patients with BLP were identified. Over a 2-year period, 7 patients were treated with BTA. Six patients had congenital idiopathic BLP. One of these had trisomy 7. One patient acquired the paralysis after cardiac surgery. No patients required a tracheostomy, except for the infant with trisomy 7. Six patients recovered function completely, and the seventh recovered it partially (range, 4 weeks to 12 months). CONCLUSIONS: Injection of BTA into external laryngeal muscles may be an alternative to tracheostomy in BLP. It is proposed that the toxin relaxes the glottic aperture by paralyzing the cricothyroid and strap muscles and that it may aid in appropriate reinnervation of the larynx via mechanisms beyond the neuromuscular junction.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".