Neonatal unilateral vocal fold paralysis may arise iatrogenically, idiopathically, or in the context of an underlying neurologic disorder. Management is often supportive, focusing on diet modification to allow for safe oral feeding. We describe the clinical course of six infants with unilateral vocal fold paralysis who developed predominantly unilateral laryngomalacia ipsilateral to the affected vocal fold with associated severe respiratory symptoms and feeding difficulty. Retrospective review of six infants with unilateral vocal fold paralysis and predominantly unilateral laryngomalacia. Charts were reviewed for etiology of vocal fold paralysis, presenting symptoms, operative details, postoperative course, and outcomes for breathing and swallowing. Etiology of vocal fold paralysis included cardiac surgery in four patients, intubation-related in one, and idiopathic in one. Presenting symptoms included increased work of breathing, stridor, feeding difficulty, respiratory failure requiring noninvasive respiratory support, and weak cry. All infants were on nasogastric tube feedings. Direct microlaryngoscopy with unilateral or predominantly unilateral (conservative contralateral aryepiglottic fold division) supraglottoplasty was performed. Stridor and work of breathing improved in all six patients within 1 week postoperatively. Oral feeding improved in three patients within 2 weeks. Three patients had persistent feeding impairment with improvement within one year. Predominantly unilateral laryngomalacia may arise in the context of unilateral vocal fold paralysis. Addressing the ipsilateral cuneiform collapse can improve breathing and feeding. This may be an under-described phenomenon and represents an additional reason to include the otolaryngologist early in the care of infants with suspected possible new unilateral vocal fold paralysis. Breathing and swallow can improve post-operatively, but feeding may remain limited by the vocal fold paralysis and any medical comorbidities. Ongoing follow-up and collaboration with speech-language pathology to optimize feeding are important.

中文翻译：

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单侧声带麻痹婴儿以单侧喉软化为主

新生儿单侧声带麻痹可能是医源性、特发性或潜在神经系统疾病引起的。管理通常是支持性的，重点是改变饮食以实现安全的口服喂养。我们描述了六名单侧声带麻痹婴儿的临床病程，这些婴儿主要出现与受影响声带同侧的单侧喉软化症，并伴有严重的呼吸道症状和喂养困难。对六名患有单侧声带麻痹和主要是单侧喉软化症的婴儿进行回顾性分析。回顾了声带麻痹病因、症状、手术细节、术后病程以及呼吸和吞咽结果的图表。声带麻痹的病因包括 4 名患者的心脏手术、1 名插管相关患者和 1 名特发性患者。出现的症状包括呼吸功增加、喘鸣、喂养困难、需要无创呼吸支持的呼吸衰竭以及哭声微弱。所有婴儿均采用鼻胃管喂养。进行直接显微喉镜检查，并进行单侧或主要单侧（保守的对侧杓状会厌襞分割）声门上成形术。术后 1 周内，所有 6 名患者的喘鸣和呼吸功均得到改善。三名患者的经口喂养在两周内得到改善。三名患者存在持续性喂养障碍，并在一年内得到改善。主要是单侧喉软化症可能发生在单侧声带麻痹的情况下。解决同侧楔骨塌陷可以改善呼吸和进食。这可能是一种未被充分描述的现象，也是让耳鼻喉科医生尽早参与疑似新发单侧声带麻痹婴儿护理的另一个原因。术后呼吸和吞咽可以改善，但进食可能仍然受到声带麻痹和任何医疗合并症的限制。与言语病理学的持续跟进和合作以优化喂养非常重要。