Vocal Fold Granuloma Causing Acute Airway Obstruction in a Pediatric Patient

Vocal fold granuloma (VFG) is a benign laryngeal lesion caused by mucosal trauma to the arytenoid cartilage. Pediatric VFG is rare and is most often associated with prolonged or traumatic intubation. We present the case of a seven-year-old male who developed a 1-cm pedunculated VFG following two separate brief intubations for minor procedures. The lesion produced a dynamic "ball-valve" effect, resulting in biphasic stridor, breathy dysphonia, and intermittent airway obstruction. While computed tomography (CT) imaging was inconclusive, laryngoscopy identified a pedunculated lesion prolapsing into the subglottis with near-complete intermittent glottic obstruction. The mass was successfully excised, and the patient was extubated after a short course of intravenous steroids with complete resolution of symptoms. This case emphasizes that VFG should remain in the differential diagnosis for pediatric patients presenting with stridor and airway compromise following even brief periods of intubation.