title: Assessment of vocal fold mobility before and after cardiothoracic surgery in children.
abstract: OBJECTIVE
  To assess the incidence of vocal fold immobility (VFI) after cardiothoracic surgery in children and to determine the factors potentially associated with this outcome.
  
  
  METHODS
  Flexible laryngoscopy to assess vocal fold mobility was performed before surgery and within 72 hours after extubation in 100 pediatric patients who underwent cardiothoracic procedures. The 2 operating surgeons recorded the surgical technique and their impression of possible injury to the recurrent laryngeal nerve. The presence of laryngeal symptoms, such as stridor, hoarseness, and strength of cry, after extubation was documented.
  
  
  RESULTS
  Of 100 children included in this study, 8 had VFI after surgery. Univariate analyses showed that these 8 patients were younger and weighed less than the patients with normal vocal fold movement. Monopolar cautery was used in all patients with VFI. On univariate analysis, factors statistically significantly associated with VFI were circulatory arrest and dissection or ligation of the patent ductus arteriosus, left pulmonary artery, right pulmonary artery, or descending aorta. However, multivariate analyses failed to show these associations.
  
  
  CONCLUSIONS
  The incidence of VFI after cardiothoracic surgery in our population of children was 8.0% (8 of 100). Of several factors found to be potentially associated with VFI on univariate analysis, none were significant on multivariate analysis. This may be a result of the few patients with VFI. A larger multicenter prospective study would be needed to definitively identify factors associated with the outcome of VFI.
authors.affiliation: Division of Pediatric Otolaryngology, BC Children's Hospital, Vancouver, Canada.
authors.forename: Luthiana F
authors.initials: LF
authors.lastname: Carpes
authors.forename: Frederick K
authors.initials: FK
authors.lastname: Kozak
authors.forename: Jacques G
authors.initials: JG
authors.lastname: Leblanc
authors.forename: Andrew I
authors.initials: AI
authors.lastname: Campbell
authors.forename: Derek G
authors.initials: DG
authors.lastname: Human
authors.forename: Marcela
authors.initials: M
authors.lastname: Fandino
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Ludemann
authors.forename: J Paul
authors.initials: JP
authors.lastname: Moxham
authors.forename: Humberto
authors.initials: H
authors.lastname: Fiori
mesh_terms: D001013:Aorta, Thoracic / Q000601:surgery; D001955:British Columbia; D002425:Cautery; D002675:Child, Preschool; D004374:Ductus Arteriosus, Patent / Q000601:surgery; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D007223:Infant; D007828:Laryngoscopy; D008297:Male; D015999:Multivariate Analysis; D011651:Pulmonary Artery / Q000601:surgery; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*; D014826:Vocal Cord Paralysis / Q000209:etiology*