Arytenoidectomy in children.

Vocal cord paralysis is the second most common cause of stridor in early infancy, and as many as 52% of patients will not recover spontaneously. Bilateral vocal cord paralysis often requires a tracheotomy for airway distress. If resolution of the bilateral vocal cord paralysis does not allow for decannulation, arytenoidectomy is an option. A retrospective review of 30 children with bilateral vocal cord paralysis who underwent an arytenoidectomy was undertaken. An external arytenoidectomy via laryngofissure was performed in 19 patients, a laser arytenoidectomy in 12 patients, and a Woodman procedure in 1 patient. Twenty-five of the 30 patients (83%) were decannulated. Decannulation was more likely after a laryngofissure (84%) than after a laser arytenoidectomy (56%). The probability of decannulation was related to the presence of concomitant conditions and the need for other airway procedures. While breathiness, hoarseness, and pitch change were common, all patients had an adequate voice postoperatively and demonstrated little change from the preoperative voice disturbance. Aspiration was a rare complication. After an adequate period of observation for spontaneous resolution, arytenoidectomy via external laryngofissure is recommended to aid in the decannulation of children with bilateral true vocal cord paralysis.