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Screening for Vocal Fold Movement Impairment in Children Undergoing Esophageal and Airway Surgery

Jay W Meisner1, Shawn Izadi1, Ali Kamran1

  • 1Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, U.S.A.

The Laryngoscope
|March 9, 2023
PubMed

Insights

Preoperative screening for vocal fold movement impairment (VFMI) is crucial in children undergoing neck or chest surgery. A significant number of patients with VFMI lack typical symptoms, highlighting the need for universal screening.

Area of Science:

  • Pediatric Surgery
  • Otolaryngology
  • Nerve Injury

Background:

  • Children undergoing cervical and/or thoracic operations face risks of recurrent laryngeal nerve injury.
  • This injury can lead to vocal fold movement impairment (VFMI), often detected only in symptomatic patients.

Purpose of the Study:

  • To determine the prevalence of VFMI in preoperative pediatric patients before at-risk operations.
  • To evaluate the benefit of screening all at-risk patients for VFMI, irrespective of symptoms.

Main Methods:

  • A single-center, retrospective review of 297 pediatric patients who underwent flexible nasolaryngoscopy between 2017 and 2021.
  • Analysis focused on the presence of VFMI and associated symptoms.

Main Results:

  • 24% of patients (72/297) had VFMI. Notably, 47% of these patients were asymptomatic.
  • History of at-risk surgery, tracheostomy, or surgical feeding tube were associated with higher VFMI likelihood.
  • Dysphonia, a key symptom, was present in only 25% of VFMI patients.

Conclusions:

  • Routine preoperative screening for VFMI is recommended for all at-risk pediatric patients.
  • Screening should be considered regardless of symptoms, especially in those with a history of at-risk surgery, tracheostomy, or feeding tube.
Abstract

Keywords:
EARLNVFMIesophageal atresiaprevalencerecurrent laryngeal nerve injuryscreeningvocal fold movement impairment

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