The natural history of vincristine-induced laryngeal paralysis in children

Abstract

Objective: To outline the natural history of vincristine-induced laryngeal paralysis (VLP) in children.

Design: Retrospective case series and review of reported cases in the English-language literature.

Setting: Tertiary pediatric center.

Patients: The study included all children with a confirmed diagnosis of VLP by inspection and with complete clinical information. The sources for patient identification were a prospectively kept database and a review of the English-language literature, conducted on PubMed since 1966, as well as a bibliography search.

Main outcome measures: Charts and literature were reviewed for demographics, primary diagnosis, other diagnoses, and duration and method of treatment. The prevalence of VLP, locally, was also calculated.

Results: Four children (3 boys and 1 girl) were identified in our database over a 5(1/2)-year period, and 10 children (1 girl, 8 boys, and 1 with sex omitted) were described in the English-language literature. Four children had unilateral vocal fold paralysis only, all left-sided. The median age was 2.6 years. Acute lymphoblastic leukemia was the underlying diagnosis in 8 patients. Two patients had Down syndrome, and 1 patient had Charcot-Marie-Tooth disease, type 1. Only 2 patients required tracheotomies, and 1 patient was treated temporarily with bilevel positive-pressure ventilation. The median duration of paralysis was 6.8 weeks. The prevalence of VLP was 1.36%.

Conclusions: The data suggest that VLP is probably underreported and possibly underdiagnosed. Endoscopic inspection is a must in all patients with airway symptoms who are receiving vincristine therapy. Early recognition of VLP is mandatory, as it is reversible, has a good prognosis, and usually needs only interruption of vincristine therapy and conservative treatment.