Induced Laryngeal Obstruction in Long-Standing Unilateral Vocal Fold Immobility in the Pediatric Population

To introduce an important and novel indication for non-selective laryngeal reinnervation (NSLR) in the pediatric cohort. We acknowledge vocal paralysis as a cause of induced laryngeal obstruction (ILO) presenting as dyspnea and share our experience with NSLR for this novel indication to address ILO in these adolescent patients.

Patient charts were reviewed retrospectively for relevant symptomology, intervention, and clinical course.

Five patients, age 9-15, at a single institution, underwent NSLR for a primary indication of dyspnea between 2014 and 2024. All patients presented with exercise-induced dyspnea as their main complaint, with 3/5 reporting some degree of dysphonia. Preoperative laryngoscopy and electromyography supported a diagnosis of long-standing unilateral paralysis with some degree of arytenoid prolapse, and NSLR was the procedure of choice, typically in tandem with injection medialization laryngoplasty. All patients reported improvement or resolution of the dyspnea, with those reporting associated signs reporting immediate resolution in stridor.

This study identifies ILO in the setting of unilateral vocal fold immobility (UVFI) and arytenoid prolapse as a novel indication for NSLR in adolescents. Whether the benefit is related to treatment of type III laryngeal synkinesis or to the overall changes to the intrinsic laryngeal musculature and arytenoid stability remains speculative but provocative in this cohort. Further prospective, multi-institutional research is needed to confirm the generalizability of this approach.