Safety and effectiveness of vocal fold injection laryngoplasty in infants less than one year of age

Ayoub, Noel; Balakrishnan, Karthik; Meister, Kara D; Grimm, David; Johnson, April; Maida, Kelli; Sidell, Douglas

doi:10.1016/j.ijporl.2023.111542

Cited by 4 publications

(3 citation statements)

References 17 publications

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“… 16 Encouragingly, complications rates remain low, reported after 0% to 17% of IL procedures with most characterized as minor; including transient increased oxygen requirement, prolonged operative time, and intraoperative laryngospasm or bronchospasm. 10 , 13 , 15 Based on the findings shown here, we corroborate that injection laryngoplasty can potentially provide improvement in objective swallowing outcomes. IL has a favorably low rate of complications, though this was a secondary objective.…”

Section: Discussionsupporting

confidence: 83%

“… 10 , 14 Objective improvement in swallow function following IL can be found for 63.6% to 89% based on VFSS aspiration rates. 10 , 13 , 15 Additionally, a systematic review of objective and subjective improvement of swallow noted an improvement in 84.5% following IL. 16 Encouragingly, complications rates remain low, reported after 0% to 17% of IL procedures with most characterized as minor; including transient increased oxygen requirement, prolonged operative time, and intraoperative laryngospasm or bronchospasm.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies offer a wide range of follow‐up times between IL and instrumental swallowing assessments, ranging from days to years. 10 , 13 , 14 , 15 , 17 Ultimately, there has been no clear data on the anticipated time to aspiration recovery for vocal cord injection pediatric patients. This timeline variability can distort improvement percentages, as children may naturally experience a spontaneous improvement in dysphagia and vocal cord function over time without interventions.…”

Section: Discussionmentioning

confidence: 99%

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Injection Laryngoplasty for Children with Dysphagia after Cardiac Surgery

Sheen,

Houser,

Olsson

et al. 2024

OTO Open

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ObjectiveTo determine whether injection laryngoplasty (IL) resolves thin liquid aspiration among children with unilateral vocal cord paralysis (UVCP) after cardiac surgery.Study DesignRetrospective case‐control.SettingTertiary children's hospital.MethodsConsecutive children (<5 years) between 2012 and 2022 with UVCP after cardiac surgery were included. Resolution of thin liquid aspiration after IL versus observation was determined for children obtaining videofluoroscopic swallow studies (VFSS).ResultsA total of 32 children with left UVCP after cardiac surgery met inclusion. Initial surgeries were N = 9 (28%) patent ductus arteriosus ligations, N = 7 (22%) aortic arch surgeries, N = 9 (28%) surgeries for hypoplastic left heart syndrome, and N = 7 (22%) other cardiac surgeries. The mean age at initial surgery was 1.8 months (SD: 3.7). All children had a VFSS obtained after surgery that confirmed aspiration. There were 17 children that obtained an IL at 33.6 months (SD: 20.9) after cardiac surgery and 15 children observed without IL procedure. No surgical complications after IL were noted. The rate of aspiration resolution based on postoperative VFSS was N = 14 (82%) for the IL group and N = 9 (60%) for the control group P = .24. Documented VFSS aspiration resolution after cardiac surgery occurred by 9.6 months (SD: 10.0) in the observation group and 47.4 months (SD: 24.1) in the IL group (P < .001).ConclusionIL can help treat aspiration in children with UVCP after cardiac surgery but the benefit beyond observation remains unclear. Future studies should continue to explore the utility for IL in managing dysphagia in this pediatric population.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Injection Laryngoplasty for Children with Dysphagia after Cardiac Surgery

Sheen,

Houser,

Olsson

et al. 2024

OTO Open

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Injection Medialization in Infants with Vocal Fold Immobility Improves Dysphagia

Siu,

Amin,

Colyer

et al. 2024

The Laryngoscope

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BackgroundUnilateral vocal fold immobility (VFI) is a known cause of morbidity amongst children following congenital heart surgery. Injection medialization (IM) provides medial distraction and improves glottic closure. Limited objective data is available for the effect of IM in young children (<2 years‐old) with VFI.MethodsRetrospective case series of infants <2 who underwent IM for VFI after congenital cardiac surgery. Primary outcome was objective reduced risk of aspiration based on Dysphagia and Outcome Severity Scores (DOSS) on Video swallow study (VFSS) performed prior to and within 4 weeks following IM. Secondary analysis included perioperative complications and number of children who were able to avoid NG or G tube placement.Results17 children <2 years of age had unilateral VFI after congenital cardiac surgery and underwent IM. The median age at time of initial cardiac surgery was 6 days (IQR 3–7). There was no intraoperative or postoperative stridor or associated complications. All 17 patients had preoperative aspiration noted on VFSS. Average swallowing outcomes on VFSS improved after IM with an increase in DOSS score (preop score 3 (IQR 2–4) to postop score 6.5 (IQR 5–7) [P = 0.001]). At 2 months following IM, of the patients who had improvement in swallowing function, 50% (n = 6) were able to feed completely orally, 25% (n = 3) were fed orally with an NG wean, and 3 (25%) had a G tube placed.ConclusionInitial results suggest that IM is safe and improves early objective swallowing outcomes in children <2 years old with VFI after congenital cardiac surgery.Level of EvidenceIV Laryngoscope, 2024

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