Unilateral Vocal Cord Paralysis in Children: Our Experience

Abstract

Objective: Review presentations, etiology, management, and outcomes of unilateral vocal cord paralysis (UVCP) managed at a single institution over a 10-year period. Method: Retrospective review at a tertiary care pediatric hospital. Forty-two patients less than 18 years old presented with UVCP between 2002 and 2011. Interventions included injection laryngoplasty, ansa cervicalis to recurrent laryngeal nerve anastomosis (AC-RLNA), and cordotomy. Outcomes measured were vocal cord motility and reports of feeding, aspiration, stridor, and voice. Results: Etiology of UVCP in the 42 patients included: surgical injury (n = 23), birth trauma (n = 10), prolonged intubation (n = 3), neurological origin (n = 2), vincristine chemotherapy (n = 2), and idiopathic (n = 2). Sixteen of the 42 (38%) patients fully recovered vocal cord mobility after an average of 6.03 months. Nine patients underwent injection laryngoplasty with either Gelfoam or Radiesse Voice and saw improvement of symptoms for a median of 2 or 4 months respectively. Two patients underwent AC-RLNA with symptom improvement or resolution beginning 6 months postoperatively. Fifteen patients did not recover motion but were asymptomatic and did not require intervention. Conclusion: Children with UVCP face airway compromise, chronic aspiration, exercise intolerance, and voice abnormalities. This study favors conservative management in the majority of cases and waiting up to 1 year prior to intervention. When spontaneous recovery does not occur, injection laryngoplasty and AC-RLNA can improve symptoms for pediatric patients.