Case series: Suture lateralization for neonatal vocal fold movement disorders

Introduction: Neonatal stridor can be caused by bilateral vocal fold paralysis (BVFP). Paradoxical vocal fold movement (PVFM), though rare, can precede BVFP. Both conditions may lead to airway obstruction requiring intervention. Suture lateralization is a minimally invasive, reversible alternative to tracheostomy. We present a case series of six infants with stridor who underwent suture lateralization. Methods: A retrospective review was conducted at a tertiary children's hospital from 2022 to 2024. Infants with BVFP or PVFM who underwent combined endoscopic and open suture lateralization were included. Results: Four patients had BVFP diagnosed at birth. Two had PVFM and were found to have TUBB3 mutations. Five patients underwent suture lateralization within the first month of life; one underwent the procedure at 12 months for episodic respiratory distress. All patients were extubated by postoperative day 3. Five of six (83 %) had no increased work of breathing on room air. One required tracheostomy due to inability to wean from positive pressure. All others maintained adequate airways at last follow-up. Five of six patients (83 %) required feeding tube placement due to aspiration. Of these, four (80 %) were tolerating purees at follow-up. Conclusions: Suture lateralization is a viable alternative to tracheostomy for infants with BVFP or PVFM and airway obstruction. While effective in avoiding tracheostomy, a higher-than-expected rate of postoperative aspiration was observed, highlighting the need for careful feeding evaluation and follow-up.