What is Vocal Cord Lateralization?

Vocal cord lateralization is a surgery that may be used to treat children with bilateral vocal cord paralysis.

Where Are Vocal Cords?

The true vocal cords (also called vocal folds) sit at the top of the voice box, or larynx, one on each side.

False vocal cords sit just above the true vocal cords in your child’s voice box (or larynx).

The true vocal cords move back and forth (vibrate) as air is blown out from the lungs. Vocal cords let us talk and they protect the windpipe, or trachea, by keeping food, drink and spit from going down the wrong way.

Nerve damage or infections can change the motion of the vocal cords for a short time (temporarily) or permanently (forever).

When one or both vocal cords cannot move (are paralyzed):

• Speaking and breathing are affected
• Air cannot pass through enlarged vocal cords, completely covering your child’s voice box or fixed in a closed position

What Is Vocal Cord Lateralization?

Surgery is one option to improve breathing and protect voicing. There are several different surgeries to help the vocal cords. The ENT doctor will complete a microlaryngoscopy and bronchoscopy (MLB) to confirm which surgery is right for your child. For this procedure, your child goes to sleep in the operating room and a special telescope is passed into your child’s airway to look for narrowing.

Vocal cord lateralization is a surgery that pulls open one of the vocal cords. To do this, the doctor will move one vocal cord to the side (or laterally). This procedure is one option for children with bilateral vocal cord paralysis. It helps make space between the vocal cords so the child can breathe better.

What Are Other Names for This Procedure?

• Endoscopic true vocal cord lateralization
• Endoscopic false vocal cord lateralization
• Open true vocal cord lateralization
• Open false vocal cord lateralization

Alternate Treatments

Other options to treat vocal cord paralysis:

• Posterior cricoid split
• Endoscopic cordotomy
• Open cordotomy
• No surgery

About the Surgery

Children are in the operating room for this surgery under general anesthesia, which means they are asleep during the procedure. The anesthesia team uses your child’s tracheostomy tube or places a breathing tube for the surgery. If a breathing tube is placed, it is removed once surgery is complete.

The surgery lasts about three to four hours. The ENT surgeon decides the best way to fix the vocal cord based on your child’s condition. The procedure is performed through the mouth or through a small cut made on the outside of the neck.

Through the mouth (endoscopic) surgery:

• The procedure is performed through the child’s mouth with small tools.
• The doctor places a small stitch around the back of a vocal cord. This stitch is tied to the side of the voice box. This stitch is not removed.
• Your child will go to the recovery room after surgery. You will be reunited with your child as soon as possible.

Open surgery:

• The doctor makes a small cut across the middle of the neck. As your child heals, this incision will look like a crease in their neck.
• A stitch is placed around the back of a vocal cord to pull it to the side. This stitch is tied to the side of the voice box and is not removed.
• A small drain is placed in the neck incision to let air and fluid out. The drain is removed after three days.
• Your child will go to the recovery room after surgery. You will be reunited with your child as soon as possible.

After the Surgery

Once your child’s breathing is stable in the recovery room, they will go to the Complex Airway Unit (high acuity unit) to be watched closely. They will stay in the hospital up to three days. Your child will likely have some throat pain after surgery, and will get pain medicine to keep them comfortable. Children gradually resume normal activities as tolerated.

Children cannot eat or drink the day of surgery. Some children have issues with swallowing (or aspiration) following this surgery. A speech therapist will check swallowing before your child can eat.

Children vary in their ability to speak, or vocalize, prior to having this surgery. The ability to vocalize after surgery will be different based on each patient. There is usually some swelling around your child’s voice box (larynx) after this surgery, which affects the ability to vocalize. Voicing is typically breathier and quieter after surgery. Voicing usually goes through slow changes and improves over several months after the surgery.

Follow-Up

There will be routine follow-up after this surgery. Microlaryngoscopy and bronchoscopy (MLB) is the name of the procedure to look at how the airway is healing. The ENT doctor decides when your child needs to have this procedure.

What to Expect after Surgery

Some children may continue to have similar symptoms of vocal cord paralysis after surgery. Typically, children have marked improvement in breathing after this surgery, such as:

• Less shortness of breath during exertion and at rest
• Decreased noisy breathing (also called stridor)
• Less work to breathe or sucking in around their ribs and chest (also called retractions)
• Able to make quality sounds or speak better

When Should You Call Your Doctor?

Call your doctor if your child experiences:

• Extreme shortness of breath during exercise or at rest
• Frequent chest infections
• Continued noisy breathing

Take your child to the hospital if they:

• Stop breathing for longer than 10 seconds
• Have dusky or blue color around lips and noisy breathing
• Have chest or neck retractions that do not stop with repositioning your child or waking your child up