Highlight
• Recurrent laryngeal nerve (RLN) reinnervation yields substantial voice improvements in 90% of pediatric patients with unilateral vocal fold paralysis (UVFP).
• The largest single-center, single-surgeon cohort (n=102) confirms both perceptual and acoustic voice measures improve markedly.
• Prematurity, prolonged intubation history, and posterior intubation deficiencies are associated with less robust voice recovery.
• Aspiration and respiratory symptoms improve or resolve in most patients following RLN reinnervation.
