Vocal fold movement impairment and aspiration risk in children undergoing aerodigestive surgery.

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.