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Unilateral vocal fold paralysis is a common complication of many procedures of the neck and chest, but is particularly common following cardiothoracic surgery.
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Symptoms of unilateral vocal fold immobility are related to all functions of the larynx, and may include stridor, dysphonia, and dysphagia.
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Work-up of these patients should include imaging of the entire length of the recurrent laryngeal nerve for anatomic causes, if the cause is not clear from patient history.
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Static and dynamic treatment
Unilateral Vocal Fold Immobility in Children
Section snippets
Key points
Epidemiology
It is difficult to obtain an accurate estimate of the prevalence of UVFP in children, although hundreds of cases of UVFP have been detailed in the literature. Diagnosis by conventional flexible nasolaryngoscopy (FNL) in children can be complicated by floppy supraglottic structures, suboptimal view, and secretions, making it challenging even for experienced examiners.2 Techniques for diagnosis are improving with the ability to record and replay examinations and higher-definition equipment. These
Causes
UVFP is a physical finding, not a diagnosis. In cases in which a UVFP is identified, the cause of the paralysis must be elucidated. Similar causes of UVFP exist for both adults and children, although the frequencies of each cause are not the same. Certain insults may cause UVFP but are more commonly associated with bilateral VFP, and these are not addressed in this article. Common causes of bilateral VFP include Arnold-Chiari and other central malformations, many peripheral neuropathies such as
Presentation
Patients with UVFP may be asymptomatic or have significant functional impairment. Any or all of the functions of the larynx may be affected. Three-quarters of affected children present with stridor.6, 7 Half experience dysphonia, and one-quarter have dysphagia. Other presentations may include poor cough, aspiration, recurrent pneumonias, reactive airway disease, and subtle feeding difficulties. Although patients with bilateral VFP may have a relatively normal voice and are more likely to
Diagnostic evaluation
The first step in evaluating a child with suspected UVFP is a thorough history and physical examination. Each facet of laryngeal function should be addressed. Is there stridor? What is the character of the child’s voice or cry? Are there associated feeding difficulties? Recurrent pneumonias or aspiration might also indicate laryngeal disorder. Surgical history with focus on cardiothoracic surgery or any procedures of the neck and chest; past medical history of congenital anomalies; and birth
Importance of Treatment
UVFP caused by a transection of the RLN is unlikely to recover. After PDA ligation, a systematic review of the literature reported recovery rates ranging from zero to 33%.53 Rates of recovery in UVFP caused by other factors also vary, with idiopathic causes recovering in roughly 40% of cases.54 Even recovery is poorly defined, and there may not be neuromotor recovery despite an improved voice over time.
There are limited data to support the belief that children with persistent isolated UVFP will
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Pediatrics
Should all newborns who undergo patent ductus arteriosus ligation be examined for vocal fold mobility?
Laryngoscope
Cited by (4)
Unilateral vocal cord paralysis due to meningoencephalitis in a pediatric patient
2021, Otolaryngology Case ReportsCitation Excerpt :Vocal cord paresis or paralysis can be caused by a lesion or insult anywhere along the course of the vagus nerve or the recurrent laryngeal nerve. Neurological etiologies include central causes, brainstem compression from an Arnold-Chiari malformation, peripheral neuropathies, and inflammatory or infectious causes, such as Guillain-Barre, varicella infection, and Lyme disease [1]. Iatrogenic peripheral nerve injuries or neuropraxia are also seen due to surgical procedures, intubation, and birth trauma.
Incidence and Recovery of Vocal Fold Immobility Following Pediatric Cardiac Operations
2021, World Journal for Pediatric and Congenital Heart SurgeryPediatric Unilateral Vocal Fold Movement Impairment: Diagnostic Tools and Management Strategies
2021, Current Otorhinolaryngology ReportsRecorded Flexible Nasolaryngoscopy for Neonatal Vocal Cord Assessment in a Prospective Cohort
2021, Annals of Otology, Rhinology and Laryngology
Disclosure: The authors have nothing to disclose.