Laryngeal Reinnervation Is Recommended Surgical Intervention for Pediatric Unilateral Vocal Fold Paralysis

by Kirsten Meenan, MD, Pranati Pillutla, MD, and Dinesh K. Chhetri, 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.com.

BACKGROUND

The management of pediatric unilateral vocal fold paralysis (pUVFP) is complex (Int J Pediatr Otorhinolaryngol. 2021. doi:10.1016/j.ijporl.2020.110553; Laryngoscope. 2015. doi:10.1002/lary.25538). Neonates and infants experience dysphagia, aspiration, weak cry, and stridor (Int J Pediatr Otorhinolaryngol. 2021. doi:10.1016/j.ijporl.2020.110553). In older children, dysphonia significantly impacts socialization and development (Int J Pediatr Otorhinolaryngol. 2021. doi:10.1016/j.ijporl.2020.110553). pUVFP has the potential for late spontaneous recovery (>12 months after injury), complicating the timing of intervention.

Management options have different risk/benefit profiles than in adults. Injection laryngoplasty (IL) requires general anesthesia and offers transient effects. Medialization thyroplasty is rarely performed due to unpredictable voice outcomes when performed under general anesthesia without intraoperative voice monitoring and the potential for decreased implant efficacy with laryngeal growth (Int J Pediatr Otorhinolaryngol. 2021. doi:10.1016/j.ijporl.2020.110553). Laryngeal reinnervation (LR) offers long-term benefits but effects are not appreciated for several months. This review describes the evidence and indications for LR in the treatment of pUVFP.

BEST PRACTICE

LR is the recommended surgical intervention for permanent pUVFP. While there is potential for late spontaneous recovery, LEMG can help decide whether to perform LR, especially when considering early intervention. LR should be offered to all patients independent of patient age or duration of denervation, as it can improve voice and swallowing. Surgeons and patients should note, however, that long-term denervation may result in a smaller degree of improvement.

Concurrent IL with LR should be considered to obtain immediate improvements in glottic function. Additional prospective studies with adequate follow-up and measurement of objective voice outcomes are required to better understand the overall positive impact of LR.