Safety and efficacy of Early injection laryngoplasty in pediatric patients

Abstract

Objective: The major morbidity of unilateral vocal fold immobility (UVFI) in children is due to aspiration. Early injection laryngoplasty (IL) can decrease aspiration risk; however, this has not been well studied in pediatric otolaryngology. This study examines safety and efficacy of early IL in children.Methods: Retrospective review of pediatric patients undergoing IL with any injectate between 2006 and 2017 within 6 months of onset of UVFI. Outcomes included diet pre-and postprocedure, incidence of aspiration-related sequelae, and adverse events.Results: Seventeen patients met eligibility criteria. Ten (58.8%) were males. Median age was 8 months (interquartile range, 2 months-11.5 years). All patients had prior surgeries; the largest subgroup (11 patients, 64.7%) had UVFI after repair of a congenital cardiac defect. Other causes included thyroidectomy, high vagal injury, and prolonged intubation. Sixteen patients underwent swallowing evaluation prior to IL and 14 patients required dietary modifications due to aspiration risk. Consistency and/or volume of oral intake improved after IL in 10 (71.4%) of them. Five patients underwent gastrostomy tube placement for significant oromotor incoordination. Children with congenital cardiac defects had more previous surgeries (3.0 ± 0.4 vs. 1.2 ± 0.2, P = .006) and were more likely to require G-tube placement due to poor feeding despite IL (45% vs. 0%, P = .05). No patients experienced adverse events due to IL; in particular, none experienced airway symptoms requiring intubation.Conclusion: Early IL in pediatric patients with UVFI is safe and can reduce aspiration and improve oral intake. Future studies should elucidate patient subgroups most likely to benefit from this intervention.

Incidence and Recovery of Vocal Fold Immobility Following Pediatric Cardiac Operations

“…13 Some children with dysphagia due to VFI can be managed with a modified diet, but others require continued enteral feeding or a gastrostomy tube. 17 In our series, the most common feeding regimen for those with VFI upon hospital discharge was a combination of oral and NG feeds. Aspiration is not uncommon.…”

“…Traditionally, medialization of the vocal fold with an absorbable biomaterial (collagen, micronized hydroxyapatite, etc) has been offered. 17,19 This procedure can offer temporary relief, as these biomaterials are absorbed within 6 months, necessitating repeat procedures. More recently, laryngeal reinnervation has been advanced as an enduring alternative.…”

Injection Laryngoplasty for Children with Dysphagia after Cardiac Surgery

“… 9 Studies of children with vocal cord immobility find that as many as 87.5% of patients will develop voice and swallowing dysfunction. 3 , 13 , 14 The dysphagia and aspiration risk can necessitate dietary modification, supplemental enteral feeds, or complete enteral feeds in 68.5% to 80.5% of children. 3 , 13 In this series, a nasogastric tube was placed in nearly all patients and dietary modification or NPO status was common.…”

Pediatric Vocal Fold Paresis and Paralysis

“…For UVFP, injection laryngoplasty provides an immediate and temporary solution to improve glottic closure in very young children (Table 2). 12,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] Periodic reinjections are necessary, as products can be resorbed within 4 weeks to 18 months. 25,43 The timing of reinjection is dependent on the chosen material, but less material is usually needed with time, as patients may one day regain vocal function through developmental maturity and compensation.…”