IntroductionVincristine is a vinca alkaloid chemotherapy agent used in the treatment haematological malignancies including acute lymphoblastic leukaemia (ALL) and some lymphomas. Common toxicity includes neuropathy which can be peripheral, autonomic or less commonly central1. Vincristine remains an essential chemotherapy agent in modern ALL protocols1,2,3. It’s mechanism of action is by inhibiting the M phase of mitosis by binding with the protein component of microtubules. Axonal degeneration takes place when axonal transport and secretory functions are impaired thus leading to apoptosis and toxicity in neural tissue. This is typically seen within the extra-ocular muscles and larynx in cranial neuropathy1.Recurrent laryngeal nerve palsy resulting in vocal cord paralysis (vcp) in children has been documented in the literature in multiple case reports and small number of case series4.We present the largest case series to date of seven children who sustained vcp secondary to vincristine chemotherapy for ALL and review the literature.