Journal of pediatric surgery · 2026
Vocal fold movement impairment and aspiration risk in children undergoing aerodigestive surgery.
СтатьяНазвание и аннотация: Перевод в очереди
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Mohamed Abdimajid, Izadi Shawn, Davidson Kathryn, Hernandez Kayla, Demehri Farokh, Mohammed Somala, Choi Sukgi, Zendejas Benjamin
Аннотация
BACKGROUND: Recurrent laryngeal nerve (RLN) injury causing vocal fold movement impairment (VFMI) is a complication of pediatric aerodigestive surgery that can lead to aspiration and respiratory morbidity. The natural history of VFMI as it relates to aspiration risk remains unclear.
METHODS: Retrospective cohort study of children (0-18 years) with new VFMI after cervicothoracic aerodigestive surgery (2018-2023). VFMI was confirmed by awake flexible nasolaryngoscopy; children with pre-existing VFMI or missing preoperative laryngoscopy were excluded. Aspiration risk was evaluated using modified barium swallow (MBS) studies interpreted via the Penetration-Aspiration Scale (PAS), categorized as no (scores 1-2), medium (3-5), or high risk (6-8). MBS timing was Immediate (≤30 days postop), Follow-Up (31-365 days), and Most Recent (latest available). Data on MBS results, diet modifications, and VFMI recovery assessed outcomes.
RESULTS: Among 317 children undergoing surgery, 50 (15.7 %) developed new VFMI. Of these, 26 (52 %) had ≥1 MBS: Immediate MBS (n = 19) showed 79 % high aspiration risk and 68 % silent aspiration; Follow-Up MBS (n = 14) showed 21 % high risk and silent aspiration; Most Recent MBS (n = 14) showed 14 % high risk and silent aspiration. Sixteen (32 %) recovered from VFMI, 14 (28 %) had persistent impairment, and 20 (40 %) lacked VFMI follow-up. No consistent relationship was found between VFMI recovery and aspiration risk improvement, although clinical improvement was observed over time.
CONCLUSION: Children with post-surgical VFMI commonly exhibit silent aspiration, highlighting limits of symptom-based screening. To guide safe oral feeding, objective and serial assessments of aspiration risk should be considered for children with new VFMI.
METHODS: Retrospective cohort study of children (0-18 years) with new VFMI after cervicothoracic aerodigestive surgery (2018-2023). VFMI was confirmed by awake flexible nasolaryngoscopy; children with pre-existing VFMI or missing preoperative laryngoscopy were excluded. Aspiration risk was evaluated using modified barium swallow (MBS) studies interpreted via the Penetration-Aspiration Scale (PAS), categorized as no (scores 1-2), medium (3-5), or high risk (6-8). MBS timing was Immediate (≤30 days postop), Follow-Up (31-365 days), and Most Recent (latest available). Data on MBS results, diet modifications, and VFMI recovery assessed outcomes.
RESULTS: Among 317 children undergoing surgery, 50 (15.7 %) developed new VFMI. Of these, 26 (52 %) had ≥1 MBS: Immediate MBS (n = 19) showed 79 % high aspiration risk and 68 % silent aspiration; Follow-Up MBS (n = 14) showed 21 % high risk and silent aspiration; Most Recent MBS (n = 14) showed 14 % high risk and silent aspiration. Sixteen (32 %) recovered from VFMI, 14 (28 %) had persistent impairment, and 20 (40 %) lacked VFMI follow-up. No consistent relationship was found between VFMI recovery and aspiration risk improvement, although clinical improvement was observed over time.
CONCLUSION: Children with post-surgical VFMI commonly exhibit silent aspiration, highlighting limits of symptom-based screening. To guide safe oral feeding, objective and serial assessments of aspiration risk should be considered for children with new VFMI.