The Department of Otolaryngology has successfully completed the first recurrent laryngeal nerve reinnervation procedure in a pediatric patient at UVA. Pediatric otolaryngologist Ariana Greenwell, MD, with the assistance of laryngologist Vanessa Torrecillas, MD, performed the procedure in a three-year-old with longstanding left vocal fold paralysis.
Unilateral vocal fold paralysis (UVFP) related to recurrent laryngeal nerve (RLN) injury can lead to significant quality of life impairments. In pediatric patients, significant impairments can occur in voice, swallowing, and breathing. In severe cases, these injuries can lead to aspiration, chronic respiratory issues, and failure to thrive. Though RLN issues can be congenital, childhood vocal fold paralysis is also noted to occur related to intubation, thoracic and esophageal surgery, and in up to 25% of cardiac surgeries.
While laryngeal reinnervation surgery has been an accepted treatment for voice changes related to UVFP in the adult population for some time, it remains relatively novel and is less commonly performed in the pediatric population. However, other traditional options for repair such as medialization laryngoplasty are limited in the pediatric population due to the growing and changing larynx. Additionally, injection laryngoplasty—a procedure in which the vocal fold can be injected with a short or long-acting bulking material—requires general anesthesia for most children. As it is only a temporary repair, many parents understandably want to avoid the recurrent anesthetic.
Laryngeal reinnervation surgery takes approximately two hours and avoids the implantation of foreign materials. In the pediatric population, patients are observed overnight due to concerns for airway swelling with discharge the following morning. Most patients are able to return to normal activities almost immediately with minimal pain. Reinnervation occurs over the course of several months and has the ability to provide lifelong improvements in voice and swallowing function for many patients.
The successful completion of this procedure highlights the innovative care we are providing at UVA Children’s Hospital in order to improve the quality of life for even our youngest patients.
Filed Under: Clinical