Faculty Collaboration Database

Vocal fold medialization in children: injection laryngoplasty, thyroplasty, or nerve reinnervation? Arch Otolaryngol Head Neck Surg 2007 Aug;133(8):767-71

Date

08/22/2007

Pubmed ID

17709613

DOI

10.1001/archotol.133.8.767

Scopus ID

2-s2.0-34548059484 (requires institutional sign-in at Scopus site)   62 Citations

Abstract

OBJECTIVE: To review surgical interventions for pediatric unilateral vocal fold immobility (UVFI).

DESIGN: Retrospective medical chart review.

SETTING: Two tertiary academic centers.

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

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

MAIN OUTCOME MEASURES: 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.

Author List

Sipp JA, Kerschner JE, Braune N, Hartnick CJ

Author

Joseph E. Kerschner MD Provost, Executive Vice President, Dean, Professor in the School of Medicine Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Anastomosis, Surgical
Brain Stem Neoplasms
Child
Child, Preschool
Female
Humans
Hypoxia, Brain
Injections
Interpersonal Relations
Male
Otorhinolaryngologic Surgical Procedures
Quality of Life
Recurrent Laryngeal Nerve
Retrospective Studies
Severity of Illness Index
Social Behavior
Thyroid Gland
Transplantation, Homologous
Vocal Cord Paralysis