Pediatric vocal fold medialization with silastic implant: intraoperative airway management

Vocal fold immobility accounts for 10% of all congenital laryngeal abnormal ities, second only to laryngomalacia. Acquired unilateral vocal fold immobi lity (UVFI) is generally due to surgical trauma. The problems associated wi th this condition include a breathy dysphonia, weak cough, and aspiration. Treatment involves observation, voice and swallowing therapy, and Various s urgical options. Medialization laryngoplasty with silastic implant (ML-s) i s a very successful procedure with consistent results in the adult populati on. It is usually done under local anesthesia with sedation to allow the Vo ice to be monitored during the procedure. The surgeon can then fashion a cu stom implant or use a specific prefabricated implant. Additionally, use of the flexible fiberoptic nasopharyngolaryngoscope (FFNPL) allows the surgeon to see the endolarynx during the procedure, thus avoiding overmedializatio n and airway obstruction. Children, however, do not tolerate such invasive procedures under local anesthesia and sedation, have much smaller airways a nd, therefore, present several problems when addressing this problem surgic ally. Management of the pediatric airway during ML-s can be achieved using a laryngeal mask airway (LMA) and the FFNPL. While this does not allow the Voice to be assessed intraoperatively, appropriate medialization of the voc al fold can be judged via the FFNPL, and airway obstruction avoided. ML-s u sing the LMA and FFNPL was performed in two children aged 8 and 4 years old . Both had excellent Voice results and no complications. The details of the se cases are reported. The literature on treatment of UVFI in children is r eviewed, and practical and theoretical issues discussed. (C) 2000 Published by Elsevier Science Ireland Ltd. All rights reserved.