109: Cricothyroid Botulinum Toxin Injection to Avert Tracheostomy in Bilateral Vocal Cord Paralysis
Bibliographic record
Abstract
Up to 59 percent of children with bilateral vocal cord paralysis require a tracheostomy for airway management. While the recurrent laryngeal nerve is usually compromised, the cricothyroid muscle, a tensor of the vocal cords has a separate innervation. We report an innovative approach whereby a tracheostomy is averted by injecting Onabotulinum Toxin into the cricothyroid muscles in patients with bilateral vocal cord paralysis. The goal is to denervate the cricothyroid muscles thereby decreasing vocal fold tension and a subsequent increase in the glottic space. We review pediatric cases of bilateral vocal paralysis managed with Onabotulinum Toxin A injections by the senior author. Medical charts were retrospectively reviewed; the clinical manifestation, injection dosage and outcomes are reported. Six patients were included. Five were female and one male infants, ranging from three weeks old to four years old. The clinical presentations included stridor and respiratory distress. We used Onabotulinum toxin to paralyze the cricothyroid muscles of five patients who would have undergone a tracheostomy for airway obstruction secondary bilateral vocal cord paralysis. We had a successful decanulation of an additional patient with a long-term tracheostomy for the same pathology. No complications were reported. Onabotulinum toxin injection in the cricothyroid muscles provides a safe, fast, effective and successful option for patients suffering with vocal cord paralysis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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 source (direct Gemma or distilled Codex), 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".