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 the 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 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):

• Affects speaking and breathing
• 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 the patient.

For this procedure, the patient goes to sleep in the operating room and a special telescope is passed into the patient’s airway to look for narrowing.

Vocal cord lateralization is a surgery that pulls open one of the vocal cords. To pull open the vocal cords, 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.

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 the patient’s tracheostomy tube or places a breathing tube for the surgery. If a breathing tube is placed, it is removed once the 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 the patient’s problem. The procedure is performed through the mouth or through a small cut made on the surface of the neck.

Through the mouth (endoscopic) surgery:

• The procedure is performed through the patient’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.
• The patient will go to the recovery room after surgery. The patient will be allowed to go home as soon as possible.

Open surgery:

• The doctor makes a small cut across the middle of the neck. As the patient heals, this incision looks like a crease on 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.

After the Surgery

Once the patient’s breathing is stable in the recovery room, they will go to the Complex Airway Unit (high acuity unit) to be watched closely. The hospital stay is up to three days. The patient will likely have some throat pain after the surgery and will be prescribed pain medicines to keep them comfortable.

Children gradually resume normal activities as much as it is possible for them. Children cannot eat or drink on the day of surgery. Some children have issues with swallowing (or aspiration) following this surgery. A speech therapist checks 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 the patient’s voice box (larynx) after this surgery, which affects the ability to vocalize. Usually voicing goes through slow changes and improves over several months after the surgery.

What to expect after the 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 sometimes 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