Pediatric Bilateral Vocal Fold Immobility: The Role of Carbon Dioxide Laser Posterior Transverse Partial Cordectomy

Vocal fold paralysis in children has been estimated to be the second most common congenital abnormality of the pediatric airway. Most commonly, children present with the vocal folds in the midline or adducted position. Pediatric patients usually have a good voice or cry and a poor airway. In these cases, the surgical goal will be improving the airway, usually by lateralizing a vocal fold, while maintaining a normal voice and intact swallowing. The focus of this article is a modification of a technique for use in adults that was introduced by Dennis and Kashima in 1989. The procedure is intended to separate the vocal ligament and vocalis muscle from the arytenoid cartilage with removal of significant tissue mass with the CO₂ laser. The demographics and results of 5 pediatric patients who underwent this procedure are discussed. The preoperative goals of airway enlargement, voice preservation, and normal deglutition were achieved in all 5 patients.