Vocal fold paralysis: role of bilateral transverse cordotomy

AbstractObjective:Although modern endoscopic laser techniques aim to avoid a permanent tracheostomy by augmenting the glottic aperture in cases of bilateral vocal fold palsy, loss of tissue from the posterior glottis risks compromising voice quality and swallowing function. The objective of this study was to describe our experience with bilateral transverse posterior cordotomy.Methods:This was a retrospective analysis of functional outcomes in a series of consecutive patients undergoing a simple modification of the classical laser cordectomy procedure, which avoids tissue loss. The procedure was confined to the complete release of the vocal ligament from the arytenoid cartilage on both sides, while avoiding any significant loss of mucosa or cartilage.Results:Post-operative voice quality and quality of life were rated as good by most patients, which makes bilateral transverse cordotomy an attractive treatment option for bilateral vocal fold paralysis.Conclusion:Bilateral transverse cordotomy is a reliable treatment option for patients with bilateral vocal fold paralysis, and aims to avoid the morbidity associated with a permanent tracheostomy.

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Functional results of endoscopic arytenoid abduction lateropexy for bilateral vocal fold palsy

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-07199-1 ◽

2021 ◽

Author(s):

László Rovó ◽

Vera Matievics ◽

Balázs Sztanó ◽

László Szakács ◽

Dóra Pálinkó ◽

...

Keyword(s):

Vocal Fold ◽

Voice Quality ◽

Functional Results ◽

Severity Index ◽

Invasive Treatment ◽

Maximum Phonation Time ◽

Motion Recovery ◽

Bilateral Vocal Fold Paralysis ◽

Vocal Fold Palsy ◽

False Vocal

Abstract Purpose Endoscopic arytenoid abduction lateropexy (EAAL) is a reliable surgical solution for the minimally invasive treatment of bilateral vocal fold palsy (BVFP), providing a stable airway by the lateralization of the arytenoid cartilages with a simple suture. The nondestructive manner of the intervention theoretically leads to higher regeneration potential, thus better voice quality. The study aimed to investigate the respiratory and phonatory outcomes of this treatment concept. Methods 61 BVFP patients with significant dyspnea associated with thyroid/parathyroid surgery were treated by unilateral EAAL. Jitter, Shimmer, Harmonics to Noise Ratio, Maximum Phonation Time, Fundamental frequency, Voice Handicap Index, Dysphonia Severity Index, Friedrich’s Dysphonia Index, Global-Roughness-Breathiness scale, Quality of Life, and Peak Inspiratory Flow were evaluated 18 months after EAAL. Results All patients had a stable and adequate airway during the follow-up. Ten patients (16.4%) experienced complete bilateral motion recovery with objective acoustic parameters in the physiological ranges. Most functional results of the 13 patients (21.3%) with unilateral recovery also reached the normal values. Fifteen patients (24.6%) had unilateral adduction recovery only, with slightly impaired voice quality. Eleven patients (18.0%) had false vocal fold phonation with socially acceptable voice. In 12 patients (19.7%) no significant motion recovery was detected on the glottic level. Conclusion EAAL does not interfere with the potential regeneration process and meets the most important phoniatric requirements while guaranteeing the reversibility of the procedure—therefore serving patients with transient palsy. Further, a socially acceptable voice quality and an adequate airway are ensured even in cases of permanent bilateral vocal fold paralysis.

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Simultaneous bilateral posterior cordectomy in bilateral vocal fold paralysis

Otolaryngology ◽

10.1016/j.otohns.2004.09.063 ◽

2005 ◽

Vol 132 (2) ◽

pp. 249-250 ◽

Cited By ~ 11

Author(s):

Mohamed Chafik Khalifa

Keyword(s):

Success Rate ◽

Vocal Fold ◽

Voice Quality ◽

Cost Effective ◽

Vocal Fold Paralysis ◽

Granuloma Formation ◽

Bilateral Vocal Fold Paralysis

The operation of simultaneous bilateral posterior cordectomy by CO2 laser was performed in 22 cases of bilateral vocal fold paralysis. The success rate was up to 92% with good airway and voice quality. The procedure is simple, cost-effective with virtually no complications. Problems related to deglutition, aspiration, or granuloma formation were not reported.

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Medial Arytenoidectomy versus Transverse Cordotomy as a Treatment for Bilateral Vocal Fold Paralysis

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940511401205 ◽

2005 ◽

Vol 114 (12) ◽

pp. 922-926 ◽

Cited By ~ 40

Author(s):

Brooke Bosley ◽

Clark A. Rosen ◽

C. Blake Simpson ◽

Brian T. McMullin ◽

Jackie L. Gartner-Schmidt

Keyword(s):

Sound Pressure Level ◽

Vocal Fold ◽

Sound Pressure ◽

Voice Quality ◽

Vocal Fold Paralysis ◽

Pressure Level ◽

Voice Handicap Index ◽

Index Score ◽

Bilateral Vocal Fold Paralysis ◽

Swallowing Difficulties

Objectives: Transverse cordotomy (TC) and medial arytenoidectomy (MA) are procedures performed to enlarge the glottic airway in patients with bilateral vocal fold paralysis (BVFP). Both are less destructive than total arytenoidectomy and have distinct theoretical advantages for voice preservation, but they have never been compared. Methods: The records of patients with BVFP treated with TC or MA were reviewed; information regarding the outcome measures of tracheotomy decannulation, dysphagia, Voice Handicap Index score, voice intensity, clinical course, and preoperative and postoperative voice quality was obtained. Results: Seventeen patients were available for evaluation (11 with TC, 6 with MA). All 6 patients with a preoperative tracheotomy were decannulated. Four patients in the MA group and 2 in the TC group had an increase in their postoperative Voice Handicap Index score. Two of the patients in the MA group had a decrease in phonatory sound pressure level of 3 dB, and 1 in the TC group had a decrease of 2 dB sound pressure level. Patient self-report of airway status following TC or MA showed that 62.5% (10 of 16) were significantly better and 25% (4 of 16) were somewhat better. Blinded audio perceptual analysis comparing preoperative and postoperative voice quality showed no difference between the MA and TC groups. A swallowing quality-of-life instrument confirmed a lack of swallowing difficulties postoperatively. Conclusions: Both TC and MA are good treatment options for BVFP, with a low incidence of complications in postoperative voice or of swallowing difficulties and a consistent improvement of laryngeal airway restriction symptoms.

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Bilateral vocal paralysis phonosurgery in adults

Acta chirurgica iugoslavica ◽

10.2298/aci0903109m ◽

2009 ◽

Vol 56 (3) ◽

pp. 109-112

Author(s):

J.P. Milovanovic ◽

V.B. Djukic ◽

A.P. Milovanovic ◽

V.Z. Djordjevic ◽

N.A. Arsovic ◽

...

Keyword(s):

Clinical Manifestation ◽

Vocal Fold ◽

Voice Quality ◽

Vocal Fold Paralysis ◽

Inspiratory Stridor ◽

Bilateral Vocal Fold Paralysis ◽

Surgical Methods

Ordinary clinical manifestation of the patient with bilaterla vocal fold paralysis is inability of abducting the cords with a result of narrowing the glottic space , causing inspiratory stridor and mild dysphonia. Such patients can be life threatened due to narrowing airway. Some kind of surgery has to be performed on these patients in order to enlarge the airway. When we treat patients with OPG, the most reasonable way is to gradually enlarge airway at glottic level and there are several surgical methods for achieving this. The least aggressive and the safest procedures are posterior transversal chordektomy (PTC) or medial aritenoidektomy (MA), after which we can perform extended versions of some of these methods or combination of both. Bilateral vocal fold paralysis has to be diagnostically different from stenosis of posterior komisure, even though the procedures such as medial aritenoidektomy, posterior transversal chordektomy and total aritenoidektomy can be performed in both cases. The patients have to be explained that the aim of the procedure is to enlarge airway to the detriment of voice quality and voice capabilities.

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A Unique Treatment Option for a Case of Congenital Bilateral Vocal Fold Paralysis

Perspectives on Voice and Voice Disorders ◽

10.1044/vvd12.1.26 ◽

2002 ◽

Vol 12 (1) ◽

pp. 26-27

Author(s):

Susan Baker

Keyword(s):

Treatment Option ◽

Vocal Fold ◽

Vocal Fold Paralysis ◽

Bilateral Vocal Fold Paralysis

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Treatment of unilateral vocal fold paralysis with ansa cervicalis to recurrent nerve anastomosis in a young adolescent: European case report

The Journal of Laryngology & Otology ◽

10.1017/s0022215118001007 ◽

2018 ◽

Vol 132 (7) ◽

pp. 661-664 ◽

Cited By ~ 5

Author(s):

C van den Boer ◽

A L Wiersma ◽

J P Marie ◽

J T van Lith-Bijl

Keyword(s):

Case Report ◽

Treatment Option ◽

Vocal Fold ◽

Voice Quality ◽

Nerve Transfer ◽

Analysis Data ◽

Vocal Fold Paralysis ◽

Recurrent Nerve ◽

Unilateral Vocal Fold Paralysis ◽

Ansa Cervicalis

AbstractBackgroundLaryngeal re-innervation in paediatric unilateral vocal fold paralysis is a relatively new treatment option, of which there has been little reported experience in Europe.MethodsIn this European case report of a 13-year-old boy with dysphonia secondary to left-sided unilateral vocal fold paralysis after cardiac surgery, the patient underwent re-innervation using an ansa cervicalis to recurrent laryngeal nerve transfer, in combination with fat augmentation, after 12 years of nerve denervation. Perceptual analysis data, and acoustic and laryngoscopy recordings were acquired pre-operatively, and at one and two years post-operatively.ResultsThe patient's perceptual voice quality was improved. He experienced subjective improvement and is very satisfied with the result. As expected, laryngoscopy at one and two years after surgery showed no physiological mobility of the vocal fold concerned, but improved closure during phonation was achieved. Electromyography showed evidence of re-innervation.ConclusionLaryngeal re-innervation could be considered as a treatment option for unilateral vocal fold paralysis in children and adolescents, even after a long-term delay.

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Laser Microsurgical Bilateral Posterior Cordectomy for the Treatment of Bilateral Vocal Fold Paralysis

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940511400804 ◽

2005 ◽

Vol 114 (8) ◽

pp. 599-604 ◽

Cited By ~ 16

Author(s):

Amo Olthoff ◽

Daniel Zeiss ◽

Rainer Laskawi ◽

Eberhard Kruse ◽

Wolfgang Steiner

Keyword(s):

Respiratory Function ◽

Vocal Fold ◽

Voice Quality ◽

Vocal Fold Paralysis ◽

The Body ◽

Bilateral Vocal Fold Paralysis ◽

Before And After ◽

Bilateral Approach ◽

Voice Preservation ◽

A Prospective Study

Objectives: We performed a prospective study to assess respiratory function and voice quality before and after laser microsurgical bilateral posterior cordectomy performed for chronic airway obstruction in patients with bilateral vocal fold paralysis. Methods: In 17 patients a laser microsurgical posterior cordectomy was performed as an immediate bilateral approach. Roughness, breathiness, hoarseness, and dyspnea were evaluated both subjectively (on a scale from 0 to 3) and objectively (body plethysmography, computerized voice analysis: Göttingen Hoarseness Diagram). Results: After laser surgery, the patients' respiratory function was significantly increased and was sufficient for all activities of daily living. The body plethysmographic measure of airway resistance had superior descriptive power and correlated significantly with the clinical degree of dyspnea (scale 0 to 3). Pretreatment and posttreatment impairment of voice quality was objectively documented with the Göttingen Hoarseness Diagram; the phonatory results measured with it correlated significantly with the subjective clinical evaluation of hoarseness. Aphonia did not occur. Conclusions: A bilateral approach for laser microsurgical posterior cordectomy combines excellent airway improvement and satisfactory voice preservation. In bilateral vocal fold paralysis, pretreatment and posttreatment clinical data should be evaluated by objective measures.

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