Percutaneous contralateral vocal fold lateralization in pediatric bilateral vocal fold paralysis

To describe a percutaneous contralateral vocal fold lateralization as an endoscopic technical modification procedure originally described by Lichtenberger for the management of pediatric bilateral vocal fold paralysis (BVFP), employing readily available materials, and to evaluate clinical outcomes in a public tertiary referral center.

This longitudinal observational case series included nine pediatric patients diagnosed with BVFP who had previously undergone tracheostomy and were managed at a tertiary university hospital in Central-West Brazil. Endoscopic vocal fold lateralization was performed using a 16-gauge peripheral intravenous catheter (Abocath®) as a substitute for the conventional Lichtenberger endo-extralaryngeal needle carrier. All procedures were conducted under general anesthesia with suspension laryngoscopy and endoscopic guidance. Postoperative primary outcome included respiratory status following decannulation over a minimum follow-up of six months, and secondary outcomes: phonatory quality, swallowing function, evidence of aspiration and other complications.

The mean age at surgery was 4 years. The predominant etiology was idiopathic (7 cases), one neurologic and other cardiac causes. All patients achieved successful decannulation (100%). Transient postoperative dysphonia was observed in all cases. No major complications, including aspiration pneumonia or lower airway infections, were documented. Two patients required revision surgery, one with contralateral and other ipsilateral lateralization. Adequate glottic airway patency was achieved in all cases, with preservation of swallowing function and satisfactory phonatory outcomes.

The proposed adaptation of the Lichtenberger vocal fold lateralization technique using a 16-gauge intravenous catheter is a safe, effective, and reproducible alternative for pediatric patients with BVFP. This low-cost modification facilitates successful decannulation while preserving laryngeal function, representing a valuable strategy in resource-limited settings and supporting vocal fold lateralization as a first-line surgical option in tracheostomized children with BVFP.