Background: Vincristine is a fundamental component in paediatric Acute Lymphoblastic Leukaemia (ALL) regimens. However, its use is frequently limited by its dose-limiting neurotoxicity. More commonly this results in peripheral and autonomic neuropathy, but occasionally manifests cranially as Vocal Cord Paralysis (VCP). Traditional diagnostics such as flexible nasal endoscopy (FNE) or micro-laryngo-tracheo-bronchoscopy (MLTB) impose significant physical distress and clinical risk in paediatric oncology patients.
Objective: To present the clinical course of a twelve-patient cohort with vincristine-induced VCP and assess non-invasive Laryngeal Ultrasound (LUS) as a diagnostic and surveillance tool.
Methods: A retrospective review of 291 paediatric patients receiving Vincristine (2010-2026) was conducted. Demographics, clinical features, diagnostic methods, management strategies and recovery timelines were analysed.
Results: Twelve patients (all B-cell ALL; 8 female) developed secondary VCP, yielding an institutional incidence of 4.1%. Median age at onset was 3 years; 11/12 had bilateral VCP. 58.3% of patients (7/12) required a tracheostomy due to severe respiratory compromise. All patients demonstrated complete resolution of VCP following modification of chemotherapy. One patient remains tracheostomy-dependent three years post-diagnosis. Previous cases were diagnosed using traditional FNE and/or MLTB; however, a recent case used FNE for initial diagnosis and LUS for surveillance, which was well-tolerated and provided full functional assessment.
Conclusion: Vincristine induced VCP is a severe toxicity associated with significant acute and long-term airway morbidity. While FNE/MLTB confirms diagnosis, LUS is a reliable, patient friendly and non-invasive alternative for assessing vocal cord mobility. Its integration into clinical protocols can minimise procedural trauma in vulnerable oncology cohorts.