title: Managing dysphonia in paediatric patients with complex airway conditions.
abstract: OBJECTIVE
  To suggest a phonosurgical management strategy that can be used for children who have previously undergone laryngotracheal reconstruction.
  
  
  METHODS
  This cases series describes three children who presented with complex, multi-level airway stenosis and marked dysphonia. Phonosurgical intervention involved endoscopic and open approaches, and was combined with voice therapy. A phonosurgical reconstruction management algorithm is suggested for evaluating and treating these complex conditions.
  
  
  RESULTS
  Pre-operative assessment is critical, and should involve voice analysis and glottal anatomy assessment using office laryngoscopy and stroboscopy. The risks must be weighed up against the benefit of vocal improvement. Surgical intervention should involve combined endoscopic and open approaches.
  
  
  CONCLUSIONS
  Voice restoration after paediatric airway reconstruction is a complex challenge. Surgical intervention should be conducted in a step-by-step manner to reduce the risk of worsening dysphonia and airway compromise. The risks and benefits must be carefully explored and discussed.
authors.affiliation: Royal National Throat,Nose and Ear Hospital,London,UK.
authors.forename: S
authors.initials: S
authors.lastname: Ojha
authors.affiliation: Department of Otology and Laryngology,Harvard Medical School,Boston,Massachusetts,USA.
authors.forename: J
authors.initials: J
authors.lastname: Setlur
authors.affiliation: Department of Speech-Language and Swallowing Disorders,Massachusetts General Hospital,Boston,Massachusetts,USA.
authors.forename: G
authors.initials: G
authors.lastname: Bunting
authors.affiliation: Department of Otology and Laryngology,Harvard Medical School,Boston,Massachusetts,USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Hartnick
mesh_terms: D000293:Adolescent; D002648:Child; D003131:Combined Modality Therapy; D003560:Cysts / Q000151:congenital / Q000175:diagnosis / Q000601:surgery; D055154:Dysphonia / Q000209:etiology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007818:Laryngeal Diseases / Q000151:congenital / Q000175:diagnosis / Q000601:surgery; D007828:Laryngoscopy / Q000379:methods; D007829:Laryngostenosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D014139:Tracheostomy / Q000009:adverse effects; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000601:surgery; D014834:Voice Training
keywords: Algorithm; Child; Dysphonia; Laryngoscopy; Voice Disorders