Pediatric type I thyroplasty: An evolving procedure

The treatment of vocal fold paralysis by type I thyroplasty in the pediatri c age group has not been reported. From 1990 to 1998, 12 type I thyroplasty procedures were performed on 8 patients between 2 and 17 years of age. The most common cause of vocal fold paralysis was neurologic, followed by vaga l injury from a cardiac procedure. The most common indications for the proc edure were aspiration and dysphonia. In our early thyroplasty experience, a dult techniques and measurements adapted after Isshiki or Netterville were used. Postoperative laryngoscopy showed that in most cases, the placement o f the implant was too high. There were variable outcomes in aspiration and dysphonia with this technique. These findings appear to be independent of t hyroplasty approach or of implant design type. We conclude that the standar d approach for vocal fold medialization in the adult cannot be applied accu rately in the pediatric population. In performing pediatric thyroplasty, th e anatomically lower position of the vocal fold must be taken into consider ation. We have since modified our technique to adjust for accurate identifi cation of the vocal fold line and medialization. The modified approach for vocal fold medialization in the pediatric population is discussed.