(Laryngeal dyskinesia)

Rare. Cause about 3 % of the neonatal and infantile stridors. Laryngeal dyskinesia is the result of a paradoxical closure of the vocal cords plane during inspiration.

Two entities have been identified:

• dyskinesias in newborns and infants: they  appear during the first day or in the first days or weeks of life. They are probably due to immaturity of the neuromuscular control of the larynx, often associated with or aggravated by vagal hypertonia or gastropharyngolaryngeal reflux. Stridor is often associated with respiratory signs, feeding difficulties and episodes of malaise or major cyanosis during crying.  Awake  laryngeal fibroscopy shows a paradoxical adduction of the vocal cords during inspiration, which disappear during involuntary respiratory movements such as coughing or laughing. Differential diagnosis in newborns : bilateral vocal cord paralysis : dyskinesia disappears under general anesthesia, while paralysis persists. Dyskinesia usually disappears before two years of age, but it is sometimes necessary to perform a temporary tracheostomy in case of severe repeated episodes of malaise.
• pseudo-dyskinesias during adolescence: it often occurs in a particular psychic context

Anesthetic implications:

management of gastroesophageal reflux, sedative premedication, increased risk of laryngospasm during induction of and awakening from anesthesia.

References : 

-        Denoyelle F, Garabedian EN, Roger G et al.
Laryngeal dyskinesia as a cause of stridor in infants.
Otolaryngol Head Neck Surg 1996;122 :612-6

-        Roger G, Denoyelle F, Garabedian EN.
Dysfonction laryngée épisodique.
Arch Pédiatr  2001; 8 (S3): 650-4

-        So RJ, Jenks C, Yi J, Ryan MA, Tunkel DE, Walsh JM.
Clinical presentation of paradoxical vocal fold motion or laryngeal dyskinesia in infants.
Int J Pediatr Otorhinolaryngol 2022 ; 162 :111304

Updated: November 2022