Pediatric recurrent laryngeal nerve reinnervation: A case series and analysis of post-operative outcomes

Abstract Objective To provide detailed information about recurrent laryngeal nerve (RLN) reinnervation outcomes in children using objective measures. Methods The records of three pediatric patients with unilateral vocal cord paralysis that underwent RLN reinnervation were retrospectively reviewed. Fundamental frequency ( F 0 ), jitter, shimmer, noise-to-harmonic ratio (NHR), and voice phonation (sustained / s /, / z /, / a /) were measured preoperatively and post-operatively at 13, 9, and 33 months (each time period corresponding to one of the three patients). Results Mean preoperative and post-operative variables were as follows: shimmer, 9.65 ± 1.02% vs. 4.46 ± 0.71% ( p  = 0.01); NHR, 0.296 ± 0.063 vs. 0.127 ± 0.011 ( p  = 0.04); jitter, 3.57 ± 0.89% vs. 1.46 ± 0.54% ( p  = 0.08); F 0 , 274.6 ± 35.4 Hz vs. 282.2 ± 70.6 Hz ( p  = 0.44); maximum phonation time, 7.46 ± 1.40 s vs. 9.79 ± 1.84 s ( p  = 0.22); / s : z / ratio, 1.28 ± 0.22 vs.1.07 ± 0.09 ( p  = 0.26). Conclusions There was statistically significant improvement in shimmer and NHR. Jitter improvement approached statistical significance. All other variables failed to show significant improvement among this small sample size. RLN reinnervation for pediatric patients is an option for the treatment of vocal cord paralysis. Further studies with larger cohorts are needed to show the full benefits.