Congenital laryngeal palsy

Congenital laryngeal palsy, also known as congenital laryngeal paralysis or congenital vocal cord paralysis, is a rare condition present at birth in which one or both vocal cords (vocal folds) fail to move properly due to impaired nerve function to the laryngeal muscles. It is one of the most common congenital anomalies of the larynx and a significant cause of stridor (noisy breathing) in newborns. The condition primarily affects the respiratory and phonatory systems, as the larynx plays a critical role in breathing, voice production, and airway protection during swallowing. Congenital laryngeal palsy may be unilateral (affecting one vocal cord) or bilateral (affecting both). Unilateral paralysis typically presents with a weak or breathy cry and mild feeding difficulties, while bilateral paralysis is more serious and often causes significant airway obstruction with inspiratory stridor, respiratory distress, and potentially life-threatening episodes of cyanosis or aspiration. Feeding difficulties and aspiration pneumonia may also occur. The condition can be isolated or associated with other congenital anomalies, including neurological conditions such as Arnold-Chiari malformation, hydrocephalus, or other central nervous system abnormalities. Some familial cases have been described, suggesting a genetic component in certain instances. Management depends on the severity and whether the paralysis is unilateral or bilateral. Mild unilateral cases may be monitored conservatively, as spontaneous recovery can occur in some patients. Bilateral vocal cord paralysis with significant airway compromise often requires surgical intervention, which may include tracheostomy to secure the airway, or later procedures such as vocal cord lateralization or arytenoidectomy to widen the airway. Speech therapy and feeding support are important components of multidisciplinary care. Long-term outcomes vary, with some children experiencing spontaneous resolution while others require ongoing airway management.

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