Injection Medialization Laryngoplasty in Children

Objective: To review our experience with vocal fold injection medialization in children. Design Retrospective case series. Setting: Tertiary care academic children's hospital. Patients: All pediatric patients at our institution who underwent injection laryngoplasty for vocal fold medialization from 2003 to 2009. Main Outcome Measures: Age, sex, indication for injection, injection material, surgical and anesthetic technique, outcomes including effect on voice and swallowing, and complications. Results: Thirteen patients underwent 27 injections. Mean patient age was 8.0 years (range, 1.3-18.0 years). The causes of glottic insufficiency included prolonged intubation (6 patients, 46%), patent ductus arteriosus ligation (2 patients, 15%), other cardiac surgery (2 patients, 15%), neck surgery or trauma (2 patients, 15%), and postviral status (1 patient, 8%). Eight patients had vocal fold paralysis or paresis; 3 had vocal fold atrophy; and 2 had vocal fold scarring. Indications for surgery included hoarseness (11 patients), aspiration (5 patients), and dysphagia without aspiration (1 patient). Materials injected included Gelfoam (n=13), Radiesse Voice (n=10), and Radiesse Voice Gel (n=4). The average number of injections per patient was 2.1 (range, 1-9). Patients experienced improvement in symptoms (subjective or objective) after injection in 24 of 27 cases (89%); 15 of 16 injections in patients with hoarseness led to improvement (94%); and 11 of 13 injections in patients with dysphagia or aspiration led to improvement (85%). One patient experienced 2 days of inspiratory stridor postoperatively, which resolved spontaneously. There were no other complications. Conclusions: This study supports injection laryngoplasty as a safe and effective intervention for children with glottic insufficiency. Further prospective studies are necessary to confirm these findings.