Implications of traumatic unilateral aryepiglottic fold injury on swallowing: A case series

• Published in: International journal of pediatric otorhinolaryngology 2023-06, Vol.169, p.111550, Article 111550
• Main Authors: Jones, Evan A., Bedwell, Joshua R., Ongkasuwan, Julina
• Format: Article
• Language: English
• Subjects: Aryepiglottic; Child; Deglutition; Deglutition Disorders - surgery; Epiglottis; Female; Humans; Infant; Intubation; Laryngeal trauma; Male; Pediatric; Pilot Projects; Retrospective Studies; Swallow
• ISSN: 0165-5876; 1872-8464
• DOI: 10.1016/j.ijporl.2023.111550

This retrospective case series examines the effect of traumatic unilateral aryepiglottic fold injury on swallowing and airway protection. It focuses on the longitudinal care of five pediatric patients to determine the dietary modifications required to maintain a safe, functional swallow. Retrospective chart review of patients with a diagnosis of unilateral aryepiglottic fold injury was performed. Cases were clinically identified by pediatric otolaryngologists at a single quaternary care pediatric hospital upon operative endoscopic evaluation. Clinical swallow outcomes were measured with the Rosenbek Penetration Aspiration Scale. Average age at diagnosis was 10 months with mean follow-up of 30 months. Eighty percent of patients were female. All patients had right-sided aryepiglottic fold injuries. Four patients were intubated for an average of 3 months and a fifth patient had a traumatic intubation event. All currently take nutrition by mouth, albeit to varying degrees. Four patients adequately protect their airway from aspiration with all oral consistencies. Optimized delivery of thin liquids yielded a Rosenbek penetration aspiration scale (PAS) score of 1 in four patients and 4 in the remaining patient. Four patients required gastric tube placement during severe illness, and three remain partially dependent. Surgical correction was attempted for one patient without improvement. Based on a limited and somewhat heterogeneous case series, the data suggests that traumatic unilateral aryepiglottic fold injury does not prohibit oral intake in most cases. While the PAS score under optimized conditions is impressive, implications for a safely tolerated diet remain. There is sparse published literature upon this topic, and the longitudinal data presented may serve as a pilot study for future investigation by shedding light on the consequences of this airway injury.