Injection Laryngoscopy as a means of resolving symptomatic vocal cord immobility after congenital heart surgery

OBJECTIVES: Vocal cord immobility immediately following cardiac surgery is associated with reduced airway protection, dysphagia and aspiration in infant and paediatric populations. Early vocal medialization shows promise in optimizing feeding outcomes and swallowing mechanics. We aim to demonstrate the outcomes of injection laryngoscopy in patients with symptomatic vocal cord immobility after paediatric cardiac surgery. METHODS: Data from cardiac surgery patients who underwent injection laryngoscopy between January 2021 and December 2024 at a single center institution were reviewed. Data was analyzed following the implementation of a vocal cord injury protocol including laryngeal ultrasound screening, preoperative dysphagia assessment, injection laryngoscopy and postoperative dysphagia evaluation as medically appropriate. RESULTS: Thirty-one patients underwent injection laryngoscopy after diagnosis of symptomatic unilateral vocal cord immobility with objectively identified dysphagia a median of 10 days (2-63) after surgery. A postoperative endoscopic or fluoroscopic swallow study was conducted with dysphagia improving or resolving in 26 of 31 patients post injection. Four patients were discharged with gastrostomy tubes. Seven patients had a documented complication including stridor, escalation of care setting, and additional required procedures. These were short-lived and often associated with underlying congenital heart disease and unrelated to vocal cord injection. CONCLUSIONS: Injection laryngoplasty as an intervention for vocal immobility and dysphagia following cardiovascular surgery is a low-risk procedure allowing safer advance of oral diet in most patients prior to discharge. We postulate it also improves dysphagia in the subacute phase and may lead to longer term benefit in glottic protection.