Pediatric Laryngeal Reinnervation: Current Evidence, Techniques, and Outcomes

This review examines the current evidence for laryngeal reinnervation as a treatment for pediatric neuronal vocal fold movement impairment (VFMI), evaluating both non-selective and selective techniques, patient selection criteria, surgical considerations, and functional outcomes. Multiple single-institution and multi-site series, along with two systematic reviews with meta-analysis, have established that non-selective ansa cervicalis-to-recurrent laryngeal nerve (NSLR) anastomosis yields significant, durable improvements in acoustic, perceptual, and quality-of-life measures, as well as dysphagia. A 2022 systematic review of 179 pediatric reinnervation procedures demonstrated statistically significant improvements in GRBAS scores (mean improvement 3.64, 95% CI 2.65–4.63) and maximum phonation time (mean improvement 5.26 s, 95% CI 4.28–6.24). National trends data confirm that NSLR is performed with increasing frequency, particularly at high-volume centers. Long-term follow-up data confirm durable voice outcomes. Laryngeal reinnervation has emerged as the preferred long-term surgical option for pediatric neuronal VFMI, addressing vocal fold tone, arytenoid position, and synkinesis without foreign body implantation. A growing body of evidence supports its safety, efficacy, and durability across the pediatric age spectrum.