Recurrent laryngeal nerve reinnervation in children: Acoustic and endoscopic characteristics pre‐intervention and post‐intervention. A comparison of treatment options

Abstract

This study presents one of the largest studies of pediatric vocal fold paralysis diagnosis and treatment. The study looks at the spectrum of function in patients with UVCP and looks at the outcomes of options: no treatment, injection laryngoplasty, and ANSA-RLN. Although surgical outcomes vary, both injection laryngoplasty and ANSA-RLN show benefit in laryngeal function, voice stability, voice capacity, perceptual rating, and pVHI scores. Both injection laryngoplasty and ANSA-RLN showed improvements post-treatment, and should be considered for management of pediatric UVCP. However, the ANSA-RLN group showed better and longer-lasting perceptual and acoustic parameters in comparison with the injection and control groups. Reinnervation, even long term after the onset of vocal fold paralysis, should be considered a viable permanent treatment for pediatric UVCP.

The natural history of recoverable vocal fold paralysis: Implications for kinetics of reinnervation

“…It has been our observation and that of others that for some patients the vocal recovery is gradual, but others experience a more abrupt onset of voice improvement that can be pinpointed to within a week or two . A similarly discrete onset of voice improvement is also noted by patients who undergo ansa cervicalis‐recurrent laryngeal nerve (RLN) reinnervation, many of whom report a transition of around 3 months postoperatively . In either case, the sudden vocal improvement likely reflects a sufficient number of regenerating axons simultaneously reaching the laryngeal adductors to produce a noticeable gain in vocal function.…”

“…2 A similarly discrete onset of voice improvement is also noted by patients who undergo ansa cervicalis-recurrent laryngeal nerve (RLN) reinnervation, many of whom report a transition of around 3 months postoperatively. [10][11][12][13] In either case, the sudden vocal improvement likely reflects a sufficient number of regenerating axons simultaneously reaching the laryngeal adductors to produce a noticeable gain in vocal function. The time from the onset of voice loss to the onset of voice improvement therefore can be regarded as a surrogate marker for the kinetics of RLN regeneration.…”

Pediatric Voice and Swallowing Disorders Related to Vocal Fold Immobility: the Use of Laryngeal EMG

“…They found no correlation with age at surgery, but there was a slight negative correlation in duration between injury and time of surgery [52••]. Zur and Carroll found that recurrent laryngeal nerve innervation has better acoustic, stroboscopic, and perceptual results than injection or observation [51]. At our center, laryngeal EMG is used before any reinnervation procedure, to assess the tracing for lack of motor unit potentials.…”

Vagal stimulation and laryngeal electromyography for recurrent laryngeal reinnervation in children

“…Various approaches to management have been described for unilateral vocal fold immobility (UVFI) in the pediatric population. Options include injection medialization laryngoplasty (IML), thyroplasty, and ansa‐to‐recurrent laryngeal nerve reinnervation (ANSA‐RLN) . ANSA‐RLN has emerged over the past decade as an effective option and is gaining popularity .…”

“…Options include injection medialization laryngoplasty (IML), thyroplasty, and ansa-to-recurrent laryngeal nerve reinnervation (ANSA-RLN). 1 ANSA-RLN has emerged over the past decade as an effective option and is gaining popularity. [2][3][4][5] A recent survey of the American Society of Pediatric Otolaryngology pediatric laryngology working group revealed that in the setting of a longstanding iatrogenic UVFI, 22% and 37% would offer ANSA-RLN and concomitant IML as a first line therapy in young children and teenagers, respectively.…”