Vocal fold medialization in children: injection laryngoplasty, thyroplasty, or nerve reinnervation?
OBJECTIVE
To review surgical interventions for pediatric unilateral vocal fold immobility (UVFI).


METHODS
Retrospective medical chart review.


METHODS
Two tertiary academic centers.


METHODS
All children who underwent vocal fold medialization for dysphonia, with or without aspiration, from January 2004 to September 2006.


METHODS
Injection laryngoplasty, ansa cervicalis-recurrent laryngeal nerve anastomosis, or thyroplasty.


METHODS
Age, sex, intervention, etiology, time from onset of UVFI to surgery, subjective success in improving voice, subjective duration of improvement, and complications.


RESULTS
Twenty-seven procedures were performed in 15 patients (mean age, 10.6 years). Nineteen injection laryngoplasties, 3 thyroplasties (1 bilateral), 2 ansa cervicalis-recurrent laryngeal nerve reinnervation procedures, 1 adduction arytenoidopexy, and 1 cricothyroid joint subluxation were performed. Causes of UVFI included thoracic surgery in 6 cases (40%), prolonged intubation in 4 (26%), central nervous system neoplasm in 3 (20%), unknown etiology in 1 (7%), and anoxic brain injury in 1 (7%). The mean duration from onset of symptoms to treatment was 47 months. There was 1 surgical complication (postoperative aspiration pneumonia following thyroplasty while the patient was under local anesthesia). Parents reported a satisfactory outcome in all cases.


CONCLUSIONS
Injection laryngoplasty, thyroplasty, and nerve reinnervation can be performed in pediatric patients with good outcomes and an acceptable safety profile. This article describes the experiences of 2 institutions with phonosurgery for UVFI in children and provides insight into the advantages and disadvantages of each procedure. Prospective studies, with validated quality-of-life measurements, are needed to greater clarify the role of different types of phonosurgery in children with UVFI.
Sipp
J Andrew
JA
Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.
Kerschner
Joseph E
JE
Braune
Nicole
N
Hartnick
Christopher J
CJ
D000293:Adolescent; D000714:Anastomosis, Surgical / Q000379:methods; D020295:Brain Stem Neoplasms / Q000150:complications; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D002534:Hypoxia, Brain / Q000150:complications; D007267:Injections; D007398:Interpersonal Relations; D008297:Male; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D011788:Quality of Life / Q000523:psychology; D012009:Recurrent Laryngeal Nerve / Q000502:physiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012919:Social Behavior; D013961:Thyroid Gland / Q000601:surgery*; D014184:Transplantation, Homologous; D014826:Vocal Cord Paralysis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*