USA: Implementing a standardized clinical pathway for managing unilateral vocal fold immobility (UVFI) after cardiothoracic surgery may improve consistency in treatment and outcome evaluation. In this cohort study, patients receiving injection laryngoplasty (IL) more often achieved early postoperative advancement to an oral diet compared with those managed conservatively. However, baseline clinical differences influenced treatment selection, indicating that improved outcomes cannot be attributed solely to the treatment approach.
Unilateral vocal fold immobility is a common complication after pediatric cardiothoracic procedures, particularly surgeries involving the aortic arch. The condition can affect swallowing and feeding, often requiring coordinated care from multiple specialties. Despite its clinical significance, standardized guidelines for managing pediatric UVFI remain limited. To address this gap, researchers led by Lacey Nelson from the Department of Otolaryngology–Head and Neck Surgery at Stanford University evaluated the outcomes of a multidisciplinary clinical protocol for infants with this condition.
The study, published in
JAMA Otolaryngology–Head & Neck Surgery, was designed as a prospective cohort study conducted at a tertiary care referral center. It included infants aged one year or younger who underwent cardiothoracic surgery involving the aortic arch between August 2015 and September 2024. Infants with a preoperative diagnosis of dysphagia, those with an adjusted age of 36 weeks or younger at surgery, and those who did not complete postoperative feeding evaluations were excluded.
Overall, 128 infants were included in the analysis. The median age at surgery was 17 days, and about 41% were female. Among these patients, 45 infants developed unilateral vocal fold immobility following surgery. Of these, 17 underwent injection laryngoplasty while 28 were treated with conservative management.
The primary outcome of the study was advancement to an oral diet before hospital discharge, defined as improvement in the frequency, volume, or consistency of oral intake. Secondary outcomes included the need for nasogastric feeding tubes, gastrostomy tube placement, and length of hospital stay.
Key Findings:
Infants who underwent injection laryngoplasty (IL) were more likely to advance to an oral diet by the time of hospital discharge compared with those managed conservatively.
All patients in the IL group (100%) achieved oral feeding advancement before discharge.
In comparison, about two-thirds of infants receiving conservative management achieved oral diet advancement.
A large proportion of infants in both groups were discharged with nasogastric feeding tubes.
The time required for nasogastric tube removal was shorter in the injection laryngoplasty group.
Hospital length of stay was similar between infants treated with injection laryngoplasty and those managed conservatively.
The researchers noted that treatment decisions were influenced by baseline clinical characteristics, which may have affected the observed outcomes. Therefore, the results cannot definitively establish the superiority of injection laryngoplasty over conservative management.
Overall, the findings suggest that adopting a standardized clinical pathway may help improve consistency in managing pediatric UVFI after cardiothoracic surgery and support better evaluation of treatment outcomes.
Reference:
Nelson L, Belsky MA, Meister KD, Balakrishnan K, Freccero A, Sidell D. Standardizing Management of Pediatric Vocal Fold Immobility After Cardiothoracic Surgery. JAMA Otolaryngol Head Neck Surg. Published online February 26, 2026. doi:10.1001/jamaoto.2026.0001
