Vocal fold avulsion in the pediatric population: Presentation and management

Abstract

Objective: Laryngeal injury among pediatric patients is uncommon; traumatic vocal fold (VF) avulsion is even more rare. The objective of this paper is to present the endoscopic management of a pediatric patient with VF avulsion and review the relevant literature.

Methods: A relevant case of a pediatric patient with a VF avulsion secondary to blunt laryngeal trauma who underwent successful endoscopic repair is presented. A comprehensive search in PubMed was conducted for cases of pediatric VF avulsion in the English-language literature.

Results: Sixteen cases of pediatric VF avulsion were reviewed (8 cases of external trauma and 8 cases of internal trauma). All cases of external laryngeal trauma presented in male patients and ranged in age from 5 to 15 years. Three patients had bilateral VF avulsions and four had unilateral avulsions. Three patients were successfully managed endoscopically. Four patients underwent tracheotomy; all patients were successfully decannulated in the postoperative period. Voice quality returned to normal for most patients. Clinical pearls and controversies in the evaluation and management of pediatric VF avulsion are presented.

Conclusions: Accurate and timely diagnosis of pediatric VF avulsion is important. CT imaging without sedation should be considered in stable patients. The endoscopic approach is the preferred method of repair when it is amenable to the extent of injury and availability of expertise from both surgeon and anesthesiologist.

Keywords: Laryngeal trauma; Pediatric vocal fold avulsion.