title: Vocal fold avulsion in the pediatric population: Presentation and management.
abstract: OBJECTIVE
  Laryngeal injury among pediatric patients is uncommon; traumatic vocal fold (VF) avulsion is even more rare. The objective of this paper is to present the endoscopic management of a pediatric patient with VF avulsion and review the relevant literature.
  
  
  METHODS
  A relevant case of a pediatric patient with a VF avulsion secondary to blunt laryngeal trauma who underwent successful endoscopic repair is presented. A comprehensive search in PubMed was conducted for cases of pediatric VF avulsion in the English-language literature.
  
  
  RESULTS
  Sixteen cases of pediatric VF avulsion were reviewed (8 cases of external trauma and 8 cases of internal trauma). All cases of external laryngeal trauma presented in male patients and ranged in age from 5 to 15 years. Three patients had bilateral VF avulsions and four had unilateral avulsions. Three patients were successfully managed endoscopically. Four patients underwent tracheotomy; all patients were successfully decannulated in the postoperative period. Voice quality returned to normal for most patients. Clinical pearls and controversies in the evaluation and management of pediatric VF avulsion are presented.
  
  
  CONCLUSIONS
  Accurate and timely diagnosis of pediatric VF avulsion is important. CT imaging without sedation should be considered in stable patients. The endoscopic approach is the preferred method of repair when it is amenable to the extent of injury and availability of expertise from both surgeon and anesthesiologist.
authors.affiliation: Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA. Electronic address: julie.strychowsky@childrens.harvard.edu.
authors.forename: Julie E
authors.initials: JE
authors.lastname: Strychowsky
authors.affiliation: Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA. Electronic address: eelam.adil@childrens.harvard.edu.
authors.forename: Eelam
authors.initials: E
authors.lastname: Adil
authors.affiliation: Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA. Electronic address: greg.licameli@childrens.harvard.edu.
authors.forename: Greg
authors.initials: G
authors.lastname: Licameli
authors.affiliation: Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, 333 Longwood Ave, 3rd Floor, Boston, MA 02115, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA. Electronic address: reza.rahbar@childrens.harvard.edu.
authors.forename: Reza
authors.initials: R
authors.lastname: Rahbar
mesh_terms: D002675:Child, Preschool; D006801:Humans; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D019838:Neck Injuries / Q000175:diagnosis / Q000601:surgery*; D014827:Vocal Cords / Q000293:injuries* / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery*
keywords: Laryngeal trauma; Pediatric vocal fold avulsion