Key Points

• Vocal fold paralysis is a risk associated with many thoracic surgical procedures.
• Paralysis significantly adds to postoperative morbidity by contributing to dyspnea on exertion due to loss of self-controlled positive end-expiratory pressure (auto-PEEP), poor cough and clearance of mucus, and aspiration.
• Unilateral vocal fold paralysis results in a breathy, weak voice.
• Bilateral paralysis causes airway compromise.
• Diagnosis is suspected based on clinical symptoms but requires direct visualization via flexible or rigid endoscopy for confirmation.
• Early treatment is recommended to decrease the risk of pulmonary complications and enhance quality of life and vocal function.

Vocal fold paralysis (VFP) is a known consequence of intrathoracic pathologic processes and is a complication of thoracic surgery. All too commonly, the issues related to VFP in thoracic disease and in patients undergoing thoracic surgery are neglected. This results in significant morbidity, mortality, and quality-of-life (QOL) issues for this patient population. VFP is accompanied by several sequelae that can greatly affect QOL and potentially can be fatal. The incidence of postoperative VFP in thoracic cancer surgery ranges between 4% and 31% in the literature and is up to 60% in the short term after esophagectomy.[1]Optimal evaluation and treatment of VFP can improve QOL and minimize an important source of morbidity and mortality after thoracic surgery.