American Association of Plastic Surgeons

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Vocal Fold Immobility after Pediatric Cardiac Operations
Jennifer M. Barr, DNP, Henry A. Milczuk, MD, Irving Shen, MD, Ashok Muralidaran, MD.
Oregon Health & Science University, Portland, OR, USA.

Objectives
True incidence of vocal fold immobility (VFI) following pediatric cardiac operations is unknown. We aim to identify the incidence of VFI after pediatric cardiac operations where the recurrent laryngeal nerve (RLN) is at high risk for injury.
Methods
Beginning November 2014, we identified all pediatric patients undergoing cardiac operations where the RLN is at risk for injury (i.e. Norwood, arterial switch operation, aortic arch operation, coarctation repair, etc.). Isolated patent ductus arteriosus ligation patients were excluded. Routine flexible laryngoscopy was performed before hospital discharge. Patients with VFI were restudied at 4 to 6 months and again at 1 year if they had persistent VFI.
Results
178 cardiac operations where the RLN was at risk for injury were performed on 176 patients. Fifty five of the 178 (30.8%) procedures resulted in VFI (complete immobility or sluggish movement). Five of 55 (9.0%) patients with VFI were asymptomatic at the time of study. Of the 97 procedures without objective findings of VFI, 12 patients were symptomatic. Thirty two of the 55 patients with VFI were restudied; 24 (71%) regained normal vocal cord function by one-year.
Conclusions
VFI is common after pediatric cardiac operations where the RLN is at risk for injury and clinical symptoms may be unreliable for identification. Vocal fold mobility should be routinely evaluated after cardiac operations where the RLN is at risk for injury. Return of normal vocal fold function is possible but follow-up for over one year is recommended.


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