Postoperative vocal cord paralysis in paediatric patients. Reports of cases and a review of possible aetiological factors.

Two cases are reported of recurrent laryngeal nerve paralysis that followed thoracic manipulations in paediatric patients. Possible aetiological factors in relation to anaesthesia and operation in paediatric and adult patients are reviewed. These include: forceful endotracheal intubation; direct surgical trauma; compression of the nerve in the neck by a tracheal cuff, or a large endotracheal tube, in the thorax by changes in the size of the great vessels; stretching of the nerve as a result of traction on distant organs; toxic effects of substances present in endotracheal tubes or formed as a result of sterilization; and the presence of a concomitant upper respiratory tract infection.