Standardizing Management of Pediatric Vocal Fold Immobility After Cardiothoracic Surgery

Area of Science:

• Pediatric Otolaryngology
• Pediatric Cardiothoracic Surgery
• Speech and Language Pathology

Background:

• Unilateral vocal fold immobility (UVFI) is a frequent complication following pediatric cardiothoracic surgery.
• Current treatment guidelines for pediatric UVFI are lacking, and existing literature on injection laryngoplasty (IL) is inconsistent.

Purpose of the Study:

• To establish a standardized, multidisciplinary protocol for managing pediatric UVFI post-cardiothoracic surgery.
• To analyze recovery patterns and outcomes in pediatric patients treated with IL versus conservative approaches.

Main Methods:

• Prospective cohort study at a tertiary care center.
• Included infants (≤1 year) undergoing aortic arch cardiothoracic surgery.
• Exclusion criteria: prematurity, preoperative dysphagia, clinical decline, or IL outside initial admission.

Main Results:

• 128 patients included; 45 (35.1%) developed UVFI.
• 17 patients underwent IL, 28 received conservative management.
• 100% of IL patients achieved oral diet advancement by discharge vs. 64.3% of non-IL patients.
• IL patients had a shorter median time to nasogastric feeding tube removal (-28 days).

Conclusions:

• A standardized clinical pathway for pediatric UVFI management can improve outcome assessment.
• IL demonstrated a higher rate of oral diet advancement in the immediate postoperative period compared to conservative treatment.
• Observed outcome differences may be confounded by baseline patient characteristics, necessitating cautious interpretation of treatment efficacy.