Paediatric recurrent laryngeal nerve reinnervation at The Children's Hospital at Westmead: a case series

Background: Paediatric unilateral vocal cord paralysis (UVCP) can be congenital or acquired and refers to immobility of a vocal cord due to disruption of its motor nerve supply. Management is based on symptomatology, and surgical intervention may be required to improve ongoing airway, phonation or aspiration issues. Recurrent laryngeal nerve (RLN) reinnervation in the adult population is well documented, and its use in the paediatric population has been popularised recently. However, experience in this group remains limited, with no cases reported to date in Australia. Methods: We report the first four cases of RLN reinnervation performed for iatrogenic UVCP at The Children's Hospital at Westmead, Australia. The indication for surgery for all four patients was dysphonia, with one patient also having swallowing dysfunction. All patients underwent left RLN re-innervation with anastomosis of a branch of ansa cervicalis to the left RLN. Results: The procedure was well tolerated in our patients, with short operating time, no post-operative complications and early discharge from hospital. Improvements in voice were noted on objective measures of voice as well as by perceptual assessment. Conclusions: In summary, we have found RLN reinnervation to be a safe procedure that, with appropriate patient selection, can be very effective in improving patients' symptoms of dysphonia and dysphagia.