Vocal Cord Medialization Laryngoplasty

What is vocal cord medialization laryngoplasty?

Vocal cord medialization is performed on some children with unilateral vocal cord immobility (having one vocal cord that is not moving). The procedure is designed to move the immobile vocal cord inward, toward the functional vocal cord. This allows the vocal cord that is moving to make contact with the immobile cord, restoring essential functions of the larynx such as voice and swallowing.

What problems can vocal cord medialization laryngoplasty fix?

When children have unilateral vocal cord immobility, they often have a weak voice and swallowing difficulties. They may be at risk of aspiration (when food or liquid accidentally enters the airway) because the vocal cords are unable to close completely during swallowing. The goal of the procedure is to move the nonworking vocal cord into a position where the working vocal cord can come into contact with it. This allows the voice box to close during swallowing and speaking. It reduces the risk of aspiration and can improve the voice’s strength.

When is vocal cord medialization laryngoplasty recommended?

First, specialists at Lucile Packard Children’s Hospital Stanford’s Aerodigestive and Airway Reconstruction Center or the Center for Pediatric Voice and Swallowing Disorders evaluate the child for problems with feeding, swallowing, and voice. We will attempt to determine the cause of the vocal cord immobility and will assess the larynx with flexible laryngoscopy or videostroboscopy. We may also use computer-based voice software to obtain specific measures of voice and airflow, and we may perform endoscopic swallowing evaluations in the clinic. If voice or swallowing problems exist, we may offer a procedure such as vocal cord medialization laryngoplasty to address the immobile vocal cord. Frequently, the vocal cord can get better spontaneously. For this reason, we take a conservative approach whenever possible and wait to see if the vocal cord will recover on its own before doing a long-lasting intervention. In the meantime, we may offer a treatment called injection medialization laryngoplasty. In this procedure, we often use a temporary injectable material to move the vocal cord closer to the functional cord. This allows the vocal cord to sit in a better position to reduce the risk of aspiration and to improve voice, while waiting for spontaneous recovery.

What procedures may be considered if the vocal cord immobility is permanent?

If the vocal cord immobility is permanent, longer-lasting injectable materials can be used, such as body fat. This allows for the vocal cord to remain medialized for a much longer period of time, and additional injections may not be required.

We also perform a more permanent procedure in teenagers and young adults called medialization thyroplasty implant. During this operation, a surgeon makes an incision in the neck and creates a small window into the larynx. The surgeon then places a permanent implant to reposition the immobile vocal cord. This procedure is often performed after a child goes through puberty, when the larynx stops growing. In some cases, this procedure is combined with another procedure, called an arytenoid adduction, to help the immobile vocal cord sit in a better position.

Under some circumstances, we perform laryngeal reinnervation procedures, which rewire the paralyzed vocal cord with a new nerve supply. Although this does not cause the vocal cord to move again, it has been shown to create long-term improvements in voice and swallowing function in children who undergo the procedure.

Who is on a child’s care team?

Our Aerodigestive and Airway Reconstruction Center and Center for Pediatric Voice and Swallowing Disorders both take a multidisciplinary approach to evaluating and treating children with unilateral vocal cord paralysis. Our team works closely with pulmonary (lung) specialists, Speech-Language Pathology, and Occupational Therapy throughout Packard Children’s to evaluate voice and swallowing disorders and to create individualized care plans. This team continues to collaborate to address a child’s swallow function, speaking, and lung function for the longer term.