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Review
. 2025 Sep 26;17(9):e93264.
doi: 10.7759/cureus.93264. eCollection 2025 Sep.

Airway Management in Patients With Vocal Cord Paralysis: A Review of Intubation Techniques, Intraoperative Challenges, and Outcomes

Rayyan Bhutta  1 , Ali Osman  1 , Tala Maya  2 , Justin Ma  3 , Ali Al Saeed  4 , Sumit Sidhu  5 , Mariya Wood  6 , Bilal Akhtar  7 , Sirimas Lau  8 , Matthias Franzen  8
Affiliations
Review

Airway Management in Patients With Vocal Cord Paralysis: A Review of Intubation Techniques, Intraoperative Challenges, and Outcomes

Rayyan Bhutta et al. Cureus. .

Abstract

Vocal cord paralysis (VCP) presents with unique challenges when managing airways, particularly during endotracheal intubation. This literature review explores the effects of unilateral and bilateral VCP on intubation technique, first-pass success, extubation safety, and perioperative airway planning. While video laryngoscopy (VL) is becoming increasingly favored for its superior airway visualization, it does not always confirm successful placement in patients with VCP. Complications such as airway edema, aspiration risk, and cuff misplacements are increased in this patient population, and they may be more vulnerable to post-extubation complications, especially without the use of steroid prophylaxis or intensive post-operative planning. A comparison of direct laryngoscopy (DL) versus VL in this patient population reveals a gap in the literature, emphasizing the need for more research in airway management in patients with VCP. This review combines current practices, clinical considerations for anesthesia providers, and identifies areas for further investigation.

Keywords: airway techniques; difficult airway intubation; difficult airway management; management of vocal cord paralysis; perioperative care.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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