We present the case of a patient with bilateral vocal fold paralysis following extensive surgical repair of congenital cardiac abnormalities and the management of the subsequent airway compromise with primary endoscopic anterior–posterior cricoid split.

Review of our management of a patient with bilateral vocal fold paralysis using anterior–posterior cricoid split and literature search of alternative management options for patients with bilateral vocal fold paralysis.

Our newborn patient developed stridor and respiratory failure following surgery for multiple cardiac malformations. Flexible fiberoptic laryngoscopy revealed bilateral vocal fold paralysis, and the patient was intubated for airway protection. We addressed the bilateral vocal fold paralysis with primary endoscopic anterior–posterior cricoid split to avoid tracheostomy, successfully extubating to room air 13 days later. The patient regained nearly total function of both folds and, at two-year follow-up, was asymptomatic from an airway, voice, sleep and swallowing perspective.

APCS was effective in managing bilateral vocal fold paralysis-associated respiratory failure and avoiding tracheostomy, with long-term follow-up demonstrating symptom resolution and bilateral recovery of laryngeal mobility.