title: Surgical Interventions for Pediatric Unilateral Vocal Cord Paralysis: A Systematic Review.
abstract: OBJECTIVE
  The most widely used surgical interventions for pediatric unilateral vocal cord paralysis include injection laryngoplasty, thyroplasty, and laryngeal reinnervation. Despite increasing interest in surgical interventions for unilateral vocal cord paralysis in children, the surgical outcomes data in children are scarce.
  
  
  OBJECTIVE
  To appraise and summarize the available evidence for pediatric unilateral vocal cord paralysis surgical strategies.
  
  
  METHODS
  MEDLINE (1946-2014) and EMBASE (1980-2014) were searched for publications that described the results of laryngoplasty, thyroplasty, or laryngeal reinnervation for pediatric unilateral vocal cord paralysis. Further studies were identified from bibliographies of relevant studies, gray literature, and annual scientific assemblies. Two reviewers independently appraised the selected studies for quality, level of evidence, and risk of bias as well as extracted data, including unilateral vocal cord paralysis origin, voice outcomes, swallowing outcomes, and adverse events.
  
  
  RESULTS
  Of 366 identified studies, the inclusion criteria were met by 15 studies: 6 observational studies, 6 case series, and 3 case reports. All 36 children undergoing laryngeal reinnervation (8 studies) had improvement or resolution of dysphonia. Of 31 children receiving injection laryngoplasty (6 studies), most experienced improvement in voice quality, speech, swallowing, aspiration, and glottic closure. Of 12 children treated by thyroplasty (5 studies), 2 experienced resolution of dysphonia, 4 had some improvement, and 4 had no improvement (2 patients had undocumented outcomes). Thyroplasty resolved or improved aspiration in 7 of 8 patients.
  
  
  CONCLUSIONS
  Published studies suggest that reinnervation may be the most effective surgical intervention for children with dysphonia; however, long-term follow-up data are lacking. With the exception of polytetrafluoroethylene injections, injection laryngoplasty was reported to be a relatively safe, nonpermanent, and effective option for most children with dysphonia. Thyroplasty appears to have fallen out favor in recent years because of difficulty in performing this procedure in children under local anesthesia, but it continues to be a viable option for children with aspiration.
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada2Division of Pediatric Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouv.
authors.forename: Oleksandr
authors.initials: O
authors.lastname: Butskiy
authors.affiliation: Division of Pediatric Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Bhavik
authors.initials: B
authors.lastname: Mistry
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada2Division of Pediatric Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouv.
authors.forename: Neil K
authors.initials: NK
authors.lastname: Chadha
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D058753:Laryngoplasty; D012009:Recurrent Laryngeal Nerve / Q000601:surgery; D014826:Vocal Cord Paralysis / Q000601:surgery*