Decision-Making in Pediatric Unilateral Vocal Fold Movement Impairment

Abstract

Unilateral vocal fold movement impairment (VFMI) in infants and children may be due to congenital, iatrogenic, or idiopathic causes and can result in stridor, dysphagia, and/or dysphonia. As a result, these patients may have longer hospital length of stays, recurrent pulmonary infections, and/or impaired psychosocial functioning. Diagnosis may be delayed because glottic incompetence can be overshadowed by other comorbid conditions such as prematurity or congenital heart disease. Iatrogenic injury is the most common cause of VFMI due to the meandering route the recurrent laryngeal nerve takes through the neck and chest. Flexible nasolaryngoscopy is typically used to diagnose VFMI, but visualizing the larynx may be challenging due to patient cooperation or anatomic limitations. Transcervical laryngeal ultrasound can be used as another means of assessing vocal fold mobility. Spontaneous vocal fold movement recovery or vocal fold compensation is frequently seen but may take months or even years to achieve. Treatment options for persistent VFMI include voice therapy, injection laryngoplasty, laryngeal framework surgery, and laryngeal reinnervation. Each of these modalities has its own advantages and disadvantages, and each may be applied in isolation or combination.