Management of bilateral vocal fold paralysis in children.

Purpose of review: Bilateral vocal fold paralysis (BVFP) is a complex condition with a range of aetiologies and clinical presentations. Whilst spontaneous improvement may occur in a significant number of cases (48-70%), in the absence of recovery, multiple operations have been used to improve the airway. This review aims to analyse recent literature surrounding the management of BVFP and discuss changes in practice.

Recent findings: Suture lateralization in neonates is an emerging trend and has been recently reported to have good success rates in managing BVFP and preventing tracheostomy. Laryngeal electromyography (L-EMG) may be used to confirm the diagnosis and differentiate from fixation. Corticobulbar motor-evoked potentials (Co-MEPs) is a complimentary technique to L-EMG, which studies the corticobulbar tract and enables visualization of the motor pathway from the brainstem to the peripheral nerves. Currently, there is no reliable method available to predict prognosis. Recent comprehensive reviews of the published literature have described the outcomes for surgical intervention, with no technique proving clearly superior overall.

Summary: The wide range of aetiologies and the variable recovery rates mean standardized management of BVFP is not possible. L-EMG is not a reliable prognostic indicator of recovery. There is an emerging trend of suture lateralization to avoid tracheostomy. Extensive recent reviews have not identified a lateralization procedure that is superior overall. Small numbers of bilateral reinnervation have reported worldwide (n = 26) with some vocal cord recovery reported but relatively low decannulation rates at present (66%).