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Paediatric injection medialisation laryngoplasty: Recent Great Ormond Street Hospital experience
K A Stephenson1, L Cavalli2, A Lambert1
1Ear, Nose and Throat Surgery, Great Ormond Street Hospital for Children, London, UK.
Insights
Injection medialisation laryngoplasty (IML) using calcium hydroxylapatite is a reliable technique for treating unilateral vocal fold paresis in children, significantly improving voice quality and patient-reported outcomes.
Area of Science:
- Otolaryngology
- Pediatric Voice Disorders
- Laryngeal Surgery
Background:
- Unilateral vocal fold paresis significantly impacts a child's voice quality and laryngeal function.
- Limited literature exists on injection medialisation laryngoplasty (IML) in pediatric cases.
- Previous studies involved small, heterogeneous patient groups.
Purpose of the Study:
- To evaluate the outcomes of IML for unilateral vocal fold paresis in children.
- To assess the efficacy of calcium hydroxylapatite as an injection material in pediatric IML.
- To analyze subjective and objective voice outcome measures post-procedure.
Main Methods:
- Retrospective review of pediatric patients undergoing IML for unilateral vocal fold paresis.
- Exclusion of cases with bilateral paresis, vocal fold fixation, or incomplete voice evaluations.
- Analysis of pre- and post-operative GRBAS scores and Voice Handicap Index.
Main Results:
- Eighteen IML procedures were performed on 12 children (ages 9-15).
- Calcium hydroxylapatite (Radiesse® Voice) was used in 13 procedures from 2011 onwards.
- Significant improvements were noted in GRBAS scores (grade, breathiness, aesthenia) and Voice Handicap Index following calcium hydroxylapatite injection.
Conclusions:
- IML using calcium hydroxylapatite is a reliable technique for pediatric unilateral vocal fold paresis.
- The procedure demonstrated improved subjective outcome measures in children.
- Further research is needed to optimize patient selection, timing, and material choice for pediatric IML.
Introduction:
Unilateral vocal fold paresis may significantly impair the vocal quality and laryngeal competence of a child. Relatively little literature relates to injection medialisation laryngoplasty (IML) in children and previous reports have involved small numbers of heterogenous cases.
Methods:
A retrospective review was conducted of paediatric patients managed by our multidisciplinary specialist voice clinic undergoing IML for unilateral vocal fold paresis. Cases of bilateral paresis, those characterised by vocal fold fixation, and patients without formal pre and post-operative voice evaluation were excluded.
Results:
Eighteen IML procedures were performed in 12 children eligible for inclusion between 2005 and 2015. The average age at time of procedure was 12 years (range 9-15 years). Autologous fat was used in 5 procedures, succeeded by calcium hydroxylapatite (Radiesse® Voice) from 2011 (n = 13). A significant improvement in median GRBAS score components was observed after calcium hydroxylapatite injection in terms of grade (p = 0.008), breathiness (p = 0.002) and aesthenia (p = 0.016). A pre- and post-procedural Voice Handicap Index was self-completed by 6 patients receiving calcium hydroxylapatite injection; the median change in score was an improvement of 19 points (interquartile range 36.5).
Conclusion:
We describe the outcomes of a comparatively large paediatric series and have found IML using calcium hydroxylapatite to be a reliable technique associated with improved subjective outcome measures. Management of UVCP in the child is a challenge with particular investigative and interventional considerations. Further study supported by high quality subjective and, where possible, objective outcome measures, is required to better inform patient selection, timing of intervention and choice of injection material.
