When Should You Perform Injection Medialization for Pediatric Unilateral Vocal Fold Immobility?

by Anne Hseu, MD, and Sukgi Choi, MD •

TRIO Best PracticeTRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.

Background

Unilateral vocal fold immobility (VFI) in the pediatric population occurs most frequently following iatrogenic injury to the recurrent laryngeal nerve. In children, the most common etiology is following patent ductus arteriosus (PDA) ligation, with children <1 kg at highest risk. VFI can result in functional difficulties including stridor and respiratory distress, aspiration and feeding problems, as well as difficulties with phonation. Recovery of nerve function is variable and can take months to years.

Injection medialization is designed to treat children with feeding difficulties and voice problems related to glottic insufficiency secondary to VFI. Whereas extensive reviews of outcomes for VFI exist in the adult literature, there is controversy over if and when to perform injection medialization in children. This review describes the evidence for injection medialization in the pediatric population.

Best Practice

Based on the current evidence, injection medialization with a temporary injectable can improve symptoms of hoarseness, dysphonia, feeding difficulties, and aspiration in pediatric patients with unilateral VFI. In many children, return of VFI or resolution of symptoms occurs over time. Temporary injection may improve morbidity during that waiting period with little risk of complications. The procedure also preserves options for reinnervation and permanent medialization thyroplasty in these children. Injection within 6 months of injury may also improve chances of long-term symptomatic improvement in adults. Further research is necessary to determine if this benefit extends to the pediatric group. (Laryngoscope. 2018;128:1259–1260).