Related Experiment Video
Updated: Jan 17, 2026

Minimally Invasive Murine Laryngoscopy for Close-Up Imaging of Laryngeal Motion During Breathing and Swallowing
Published on: December 1, 2023
Vocal fold movement impairment and aspiration risk in children undergoing aerodigestive surgery
Abdimajid Mohamed1, Shawn Izadi1, Kathryn Davidson2
1Department of Pediatric Surgery, Esophageal and Airway Treatment Center, Boston Children's Hospital, Boston, MA, USA.
Background:
Recurrent laryngeal nerve (RLN) injury causing vocal fold movement impairment (VFMI) is a complication of pediatric aerodigestive surgery that can lead to aspiration and respiratory morbidity. The natural history of VFMI as it relates to aspiration risk remains unclear.
Methods:
Retrospective cohort study of children (0-18 years) with new VFMI after cervicothoracic aerodigestive surgery (2018-2023). VFMI was confirmed by awake flexible nasolaryngoscopy; children with pre-existing VFMI or missing preoperative laryngoscopy were excluded. Aspiration risk was evaluated using modified barium swallow (MBS) studies interpreted via the Penetration-Aspiration Scale (PAS), categorized as no (scores 1-2), medium (3-5), or high risk (6-8). MBS timing was Immediate (≤30 days postop), Follow-Up (31-365 days), and Most Recent (latest available). Data on MBS results, diet modifications, and VFMI recovery assessed outcomes.
Results:
Among 317 children undergoing surgery, 50 (15.7 %) developed new VFMI. Of these, 26 (52 %) had ≥1 MBS: Immediate MBS (n = 19) showed 79 % high aspiration risk and 68 % silent aspiration; Follow-Up MBS (n = 14) showed 21 % high risk and silent aspiration; Most Recent MBS (n = 14) showed 14 % high risk and silent aspiration. Sixteen (32 %) recovered from VFMI, 14 (28 %) had persistent impairment, and 20 (40 %) lacked VFMI follow-up. No consistent relationship was found between VFMI recovery and aspiration risk improvement, although clinical improvement was observed over time.
Conclusion:
Children with post-surgical VFMI commonly exhibit silent aspiration, highlighting limits of symptom-based screening. To guide safe oral feeding, objective and serial assessments of aspiration risk should be considered for children with new VFMI.
Related Concept Videos
Suctioning the Oropharyngeal Airway
After assembling the equipment, the nurse should practice hand hygiene and don appropriate PPE according to infection control guidelines to avoid the...
Esophageal Strictures-II: Clinical Features and Management
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
Assessment of Airway, Skin Color, and Use of Accessory Muscles
Introduction
The initial evaluation of a patient's respiratory system...
Cardiopulmonary Resuscitation II: ACLS Airway Management
Respiratory System Abnormal Finding II: Palpation and Auscultation
Palpation Findings
During a respiratory assessment, palpation can reveal several vital abnormalities:
Larynx
Anatomy of the Larynx
The larynx consists of various components, including cartilage, muscles, and vocal cords. Its structure includes three large unpaired cartilages—the thyroid, cricoid, and epiglottis—and three smaller paired cartilages—the arytenoids,...

