Laryngeal abductor paralysis

Laryngeal abductor paralysis (also known as vocal cord abductor paralysis or bilateral abductor vocal cord paralysis) is a rare condition in which the muscles responsible for opening (abducting) the vocal cords fail to function properly. The posterior cricoarytenoid muscles, which are the only muscles that abduct the vocal cords, are affected, resulting in the vocal cords remaining in a closed or near-closed (adducted) position. This primarily affects the respiratory system, as the inability to open the vocal cords during breathing leads to airway obstruction, which can be life-threatening, particularly in infants and young children. Key symptoms include inspiratory stridor (a high-pitched breathing sound during inhalation), respiratory distress, episodes of cyanosis (bluish discoloration of the skin due to lack of oxygen), and a weak or breathy cry in infants. In severe cases, the airway obstruction can be significant enough to require emergency intervention. The condition may present at birth or develop during infancy, and in some familial forms, it follows an autosomal dominant inheritance pattern with variable expressivity. Some cases may be associated with neurological abnormalities or may occur as an isolated finding. Treatment depends on the severity of airway compromise. Mild cases may be managed conservatively with close monitoring, as some children experience spontaneous improvement over time. More severe cases often require tracheostomy to secure the airway. Surgical interventions such as vocal cord lateralization procedures (arytenoidectomy or cordotomy) may be considered to widen the airway, though these procedures carry a risk of affecting voice quality. Long-term follow-up with otolaryngology and pulmonology specialists is essential to monitor airway status and manage complications.

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