Unilateral vocal cord paralysis associated with subdural haemorrhage in a newborn infant

Abstract

A term infant developed stridor, hoarse cry and respiratory distress after forceps-assisted delivery. Oral feeding resulted in aspiration. Flexible laryngoscopy showed a right-sided vocal cord paralysis (VCP). A magnetic resonance image (MRI) of the brain revealed an ovoid lesion in the posterior fossa impinging on the brainstem, which was considered to represent a subdural haematoma. Clinical signs of vocal cord palsy and the associated MRI changes resolved spontaneously by 6 weeks of age. Vocal cord palsy is a common cause of stridor in newborn infants, although in many cases it is considered idiopathic. This is the first report of vocal cord palsy associated with subdural haemorrhage after instrumental delivery, and may represent an important and previously unappreciated cause of VCP. This case highlights the importance of magnetic resonance brain imaging in those infants with VCP in whom the aetiology is uncertain.

Aspiration in children with unilateral vocal fold paralysis

“…Whereas surgical treatment for vocal fold paralysis in adults is largely based on persistent dysphonia, there is no clear algorithm to determine which patients warrant surgical intervention in the pediatric population. Because pediatric cases of vocal fold paralysis may spontaneously resolve at variable rates based on etiology—particularly in unilateral cases—permanent procedures to medialize the vocal fold may be delayed until deemed necessary . It is particularly important to monitor swallowing during this time with at least one feeding evaluation and/or MBS study, as this serves as a useful tool in guiding management and feeding therapy.…”

Vocal Fold Immobility due to Birth Trauma: A Systematic Review and Pooled Analysis

“…Resolution in our own cohort was defined as follow‐up flexible nasolaryngoscopy at least 1 week after diagnosis that demonstrated a return to normal mobility in both true vocal folds. Resolution in the literature consisted of various definitions, ranging from improved feeding tolerance and resolution of stridor to (in the majority of studies) visualization by endoscopy 8,11–13 . Cases in which “partial recovery” was reported were not counted as achieving resolution.…”

“…Resolution in the literature consisted of various definitions, ranging from improved feeding tolerance and resolution of stridor to (in the majority of studies) visualization by endoscopy. 8,[11][12][13] Cases in which ''partial recovery'' was reported were not counted as achieving resolution. Because certain studies examined only bilateral VFI, [14][15][16][17][18][19][20][21] a second analysis of pattern of immobility was performed, with these studies excluded.…”

“…In total, 24 articles met all inclusion criteria for our systemic review (PRISMA flowchart in Figure 1). 3,4,7,8,[11][12][13][14][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Manual review of these references provided no further relevant studies. The evidence level for all included articles was 4, as all were cases series or case reports.…”

İdiyopatik konjenital tek taraflı vokal kord paralizisi: yenidoğanda tekrarlayan pnömoni ataklarının nadir bir nedeni

“…Konjenital vokal kord paralizisi, laringomalaziden sonra konjenital stridorun en sık nedenidir, tek taraflı veya çift taraflı görülebilir, çift taraflı vokal kord paralizisinde stridor daha belirgindir. Konjenital vokal kord paralizisi doğum travmasına, santral sinir sisteminin konjenital hastalıkları veya anomalilerine bağlı olabileceği gibi idiyopatik de olabilir [3][4][5][6][7] . Tek taraflı vokal paralizileri iyi tolere edilebilirken çift taraflı paralizi olan vakalarda trakeostomi gerektiren hava yolu obstrüksiyonu gibi daha ciddi sorunlar görülebilir.…”