Endoscopic posterior cricoid split with costal cartilage graft in pediatric bilateral vocal cord paralysis: A retrospective institutional series and literature comparison.

OBJECTIVE

The study aimed to evaluate the clinical outcomes of endoscopic posterior cricoid split with costal cartilage grafting (EPCSCG) in pediatric patients with bilateral vocal cord paralysis (BVCP) and compare these results with those in the existing literature.

METHODS

This retrospective case series included pediatric patients (≤18 years) who underwent EPCSCG between 2017 and 2024 at a tertiary care center. Data were extracted from operative reports, clinical notes, and endoscopy records. The primary outcomes included tracheostomy status, decannulation rate, breathing function (Empey Index), swallowing outcomes (dysphagia outcome and severity scale [DOSS]), and voice assessment (Voice Handicap Index-10 [VHI-10]). A structured literature review was also conducted for comparison.

RESULTS

The study included nine patients (median age: 3 years, interquartile range: 1-6 years). Four patients underwent preoperative tracheostomy, and all underwent successful decannulation. Tracheostomy was avoided entirely in the remaining five patients, resulting in a 100 % tracheostomy-free rate. The Empey Index improved postoperatively in two-thirds of the tested patients. Voice outcomes remained impaired with a moderately elevated mean VHI-10 score of 20.7. No major complications occurred, and additional surgeries were performed in four patients, including balloon dilations for subglottic stenosis, partial laser arytenoidectomy, right vocal cord suture lateralization, adenoidectomy, and tracheocutaneous fistula repair. A literature comparison revealed a wide variability in decannulation rates (28.6-100 %) and inconsistent reporting of voice and swallowing outcomes.

CONCLUSION

EPCSCG is a safe and effective surgical option for pediatric patients with BVCP that achieves excellent decannulation and swallowing outcomes. Persistent dysphonia remains a limitation, highlighting the need for comprehensive preoperative and postoperative functional assessments.