Endoscopic vocal fold lateralization using the lichtenberger needle holder in neonates and infants with bilateral vocal fold paralysis: A single-center case series.

BACKGROUND: Bilateral vocal fold paralysis (BVFP) is a rare but potentially life-threatening cause of respiratory distress in newborns and infants. Although tracheotomy has traditionally been the standard treatment for severe airway obstruction, less invasive surgical alternatives have been developed to avoid associated morbidity. Endoscopic vocal fold lateralization (EVFLA) represents one such approach. OBJECTIVE: To evaluate the safety and efficacy of EVFLA using the Lichtenberger needle holder as an alternative to tracheotomy in neonates and infants with respiratory distress caused by BVFP. METHODS: This retrospective, single-center study included 8 infants younger than 6 months who underwent EVFLA between January 2017 and January 2025 at a tertiary pediatric airway center. All patients presented with significant respiratory distress requiring non-invasive ventilation (NIV). Preoperative, perioperative, and postoperative data were collected, with a minimum follow-up of 12 months. Primary outcome was the need for tracheotomy following surgery. Secondary outcomes included ventilatory status, feeding outcomes, complications, reinterventions, and dysphonia. RESULTS: Tracheotomy avoidance rate was 100%. Median duration of postoperative intubation was 1 day, median duration of continuous postoperative NIV was 1.5 days. At final follow-up, 6 patients achieved exclusive oral feeding, while persistent clinical aspiration was observed in only 1 patient. Three patients required revision surgery because of minor complications, including laryngeal edema, suture loosened, mild glottic synechia. Dysphonia was reported in 3 patients. No patient experienced structural damage to the vocal folds. CONCLUSIONS: EVFLA using the Lichtenberger needle holder may represent a safe, effective, minimally invasive alternative to tracheotomy in newborns with BVFP-related airway obstruction.