Injection Laryngoplasty for Children with Dysphagia after Cardiac Surgery

Area of Science:

• Pediatric Otolaryngology
• Pediatric Cardiology
• Pediatric Gastroenterology

Background:

• Unilateral vocal cord paralysis (UVCP) is a known complication following pediatric cardiac surgery.
• Aspiration of thin liquids poses significant risks to affected children, including pneumonia and malnutrition.
• Current management strategies for post-cardiac surgery UVCP-induced aspiration vary, necessitating evaluation of treatment efficacy.

Purpose of the Study:

• To investigate the effectiveness of injection laryngoplasty (IL) in resolving thin liquid aspiration in children with UVCP post-cardiac surgery.
• To compare aspiration resolution rates between children undergoing IL and those managed with observation.

Main Methods:

• A retrospective case-control study was conducted at a tertiary children's hospital.
• Included were children under 5 years old diagnosed with UVCP after cardiac surgery between 2012 and 2022.
• Videofluoroscopic swallow studies (VFSS) were used to assess thin liquid aspiration resolution in the IL group (n=17) and the observation group (n=15).

Main Results:

• While the IL group showed a higher resolution rate (82%) compared to the observation group (60%), this difference was not statistically significant (P=0.24).
• However, the time to documented aspiration resolution was significantly longer in the IL group (47.4 months) than in the observation group (9.6 months) (P<0.001).
• No surgical complications were reported following injection laryngoplasty.

Conclusions:

• Injection laryngoplasty may offer a treatment option for aspiration in pediatric UVCP patients post-cardiac surgery.
• The added benefit of IL over conservative observation for aspiration resolution remains uncertain.
• Further research is warranted to clarify the role of IL in managing dysphagia in this specific pediatric population.