Outcomes of Recurrent Laryngeal Nerve Reinnervation for Pediatric Unilateral Vocal Fold Paralysis

Recurrent laryngeal nerve (RLN) reinnervation has demonstrated high success rates for treatment of pediatric unilateral vocal fold paralysis (UVFP) in small cohorts. The study objective was to describe voice outcomes from the largest single-center, single-surgeon experience with RLN reinnervation for pediatric UVFP.

This retrospective case series was conducted at a tertiary care children's hospital from 2007 to 2025. All patients who underwent RLN reinnervation for pediatric UVFP were included. Primary outcomes were perceptual and acoustic voice measures. Secondary outcomes included aspiration and dyspnea/stridor outcomes and identification of clinical factors associated with voice outcomes.

In total, 102 patients underwent RLN reinnervation. Seventy-one patients (70%) had evaluable voice outcomes. "Moderate" to "dramatic" voice improvements were observed in 64/71 patients (90%). In the 53 patients with "dramatic" voice improvement, significant improvements were observed in pVHI (-15.9), GRBAS (-3.0), and Cepstral values (+2.1 dB), with 31/46 (67%) achieving near-normal or normal Cepstral values. Female sex, decreasing gestational age, history of prolonged intubation, and presence of posterior intubation deficiency were associated with less robust voice outcomes. Aspiration was present in 25% of patients and resolved in 80% with follow-up (12/15). Dyspnea/stridor suggestive of synkinesis was present in 5% of patients and resolved in all.

RLN reinnervation is an effective intervention for treatment of pediatric UVFP. Patients with significant intubation history, posterior intubation deficiencies, and more severe prematurity are at higher risk for less than "dramatic" voice outcomes.