Pediatric Vocal Fold Paralysis.

Pediatric vocal fold paralysis (VFP) remains challenging to diagnose and manage. Iatrogenic VFP is the most common subtype, often associated with cardiac surgeries. Unilateral VFP typically manifests as dysphonia, stridor, and feeding difficulties, while bilateral VFP usually presents with more severe stridor and respiratory distress. Flexible laryngoscopy is the gold standard for diagnosis, though vocal fold ultrasound is a reasonable alternative. Injection laryngoplasty can be a short-term treatment for unilateral VFP, and recurrent laryngeal nerve reinnervation for long-term treatment. Bilateral VFP may require tracheostomy, though several different surgical interventions have proven successful in avoiding tracheostomy or facilitating decannulation.