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Vocal fold medialization in children: injection laryngoplasty, thyroplasty, or nerve reinnervation?Sipp JA; Kerschner JE; Braune N; Hartnick CJArch Otolaryngol Head Neck Surg 2007[Aug]; 133 (8): 767-71OBJECTIVE: 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.|*Transplantation, Homologous[MESH]|Adolescent[MESH]|Anastomosis, Surgical/methods[MESH]|Brain Stem Neoplasms/complications[MESH]|Child[MESH]|Child, Preschool[MESH]|Female[MESH]|Humans[MESH]|Hypoxia, Brain/complications[MESH]|Injections[MESH]|Interpersonal Relations[MESH]|Male[MESH]|Otorhinolaryngologic Surgical Procedures/*methods[MESH]|Quality of Life/psychology[MESH]|Recurrent Laryngeal Nerve/*physiology[MESH]|Retrospective Studies[MESH]|Severity of Illness Index[MESH]|Social Behavior[MESH]|Thyroid Gland/*surgery[MESH]|Vocal Cord Paralysis/*etiology/physiopathology/*therapy[MESH] |