5 Years of Diode Laser “Π” Technique for Bilateral Vocal Fold Immobility: A Technique That Improves Airway and Is Friendly to the Voice

Background: To demonstrate the efficacy of a new laser surgical technique for bilateral vocal fold immobility (BVFI) on postoperative quality of voice and swallowing. Methods: Prospective study in a tertiary university hospital and a private hospital. Patients with iatrogenic BVFI were included. Outcome measures were Voice Handicap Index 10, 10-item Eating Assessment Tool, flexible laryngoscopy, and success of decannulation. Results: Forty patients with post thyroidectomy BVFI were initially enrolled in our study; only 12 patients returned questionnaires and kept their follow-ups and were included in the study. All patients were successfully decannulated and remain decannulated up to 24-month follow-up. There was a statistically significant improvement in quality of swallowing and no significant deterioration in quality of voice. There was no need for revision up to 24-month follow up. Conclusions: The “Π” technique using diode laser technology is a new and safe technique for BVFI with excellent long-term decannulation rates and improvement in quality of life and swallowing without significant changes in voice quality.

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Effect of Unilateral Cordotomy on Perception of Dysphagia

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419898711 ◽

2019 ◽

Vol 129 (6) ◽

pp. 536-541

Author(s):

Melissa Conklin ◽

Matthew S. Clary ◽

Elizabeth M. Cuadrado ◽

Marie E. Jetté

Keyword(s):

Vocal Fold ◽

Assessment Tool ◽

Swallowing Function ◽

Post Surgery ◽

Bilateral Vocal Fold Paralysis ◽

Patient Reported ◽

Specific Outcome ◽

Vocal Fold Immobility ◽

Bilateral Vocal Fold Immobility

Objectives: CO2 laser medial transverse cordotomy is a permanent static procedure performed to achieve adequate functional airway in cases of posterior glottic stenosis and bilateral vocal fold paralysis. Although it is the preferred method to manage long-term bilateral vocal fold immobility, it is widely believed that cordotomy has the potential to cause aspiration. The minimal existing data on the effect surgical enlargement of the glottic airway on swallowing function is heterogeneous. Through investigation of dysphagia after cordotomy, we hope to better understand the influence of glottic function and its role in dysphagia. The Eating Assessment Tool (EAT-10), is a validated dysphagia symptom-specific outcome measure. We hypothesized that EAT-10 scores would not change after CO2 laser cordotomy despite causing glottic insufficiency. Methods: Retrospective review was performed on sequential patients having undergone unilateral CO2 laser cordotomy with complete pre- and postoperative EAT-10 questionnaire data available for evaluation. Results: Fifteen patients were available for analysis; 10 patients underwent primary unilateral medial transverse cordotomy, 5 patients underwent revision cordotomy, and 20 unique procedures were included in the dataset. The median EAT-10 score during the visit prior to surgery was 3.5, whereas the post-surgery median score was 2. Furthermore, the median difference of 0 was statistically non-significant ( P = .91). Conclusion: CO2 laser cordotomy does not contribute to patient-reported dysphagia despite creating glottic incompetence. This suggests vocal fold apposition may play a less significant role in normal swallowing function than widely believed.

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Unilateral transverse cordotomy for bilateral abductor vocal fold immobility

The Journal of Laryngology & Otology ◽

10.1017/s0022215112001521 ◽

2012 ◽

Vol 126 (9) ◽

pp. 913-917 ◽

Cited By ~ 4

Author(s):

J M Bernstein ◽

S M Jones ◽

P H Jones

Keyword(s):

Vocal Fold ◽

Case Series ◽

University Hospital ◽

Symptom Scale ◽

Voice Change ◽

Airway Function ◽

Scale Scores ◽

Before And After ◽

Vocal Fold Immobility

AbstractObjective:We present a case series with airway compromise due to bilateral abductor vocal fold paralysis or fixation, treated with unilateral transverse cordotomy.Methods:Of eight consecutive patients with dyspnoea due to bilateral paramedian vocal fold immobility, seven underwent unilateral transverse cordotomy between August 2006 and April 2010 at University Hospital of South Manchester, UK. Airway and voice outcomes were compared before and after surgery.Results:All seven treated cases derived subjective airway function improvement; there was no aspiration. The eighth case had inadequate access. None of the seven treated patients required contralateral cordotomy or permanent tracheostomy. One treated case required a temporary tracheostomy; unilateral transverse cordotomy facilitated eventual decannulation. Two patients died of cancer at five and six weeks, variously. At a mean follow up of 22 months, four cases showed unchanged or slightly worse Voice Symptom Scale and Grade-Roughness-Breathiness-Asthenia-Strain scale scores.Conclusion:In patients with bilateral abductor vocal fold immobility, unilateral transverse cordotomy results in improved dyspnoea with either no voice change or only slight worsening. This is a more conservative procedure than bilateral transverse cordotomy, with the potential for better preservation of voice and breath support.

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Quality of Voice and Prognostic Markers for the Recovery of Vocal Fold Paralysis After Thyroid Surgery

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419858629 ◽

2019 ◽

Vol 128 (12) ◽

pp. 1104-1110 ◽

Cited By ~ 1

Author(s):

Rudolf Reiter ◽

Adrienne Heyduck ◽

Thomas Karl Hoffmann ◽

Sibylle Brosch ◽

Maria Anna Buchberger ◽

...

Keyword(s):

Thyroid Gland ◽

Vocal Fold ◽

Complete Recovery ◽

Vocal Fold Paralysis ◽

Predicting Factors ◽

Quality Of Voice ◽

Thyroid Gland Surgery ◽

The Voice

Objectives: This study is set to analyze clinicopathological factors predicting the recovery of unilateral vocal fold paralysis (UVP) in patients after thyroid gland surgery. The quality of voice was additionally assessed in these patients. Methods: The charts and videolaryngostroboscopy (VLS) examinations of 84 consecutive patients with a complete UVP after surgery of the thyroid gland were retrospectively reviewed. Patients were divided into 2 groups: patients who fully recovered from vocal fold paralysis and those who failed to recover after a follow-up of 12 months. The quality of voice was analyzed among other things by determining the Voice Handicap Index (VHI). Results: The UVP fully recovered in 52 of 84 (61.9%) patients. Positive mucosal waves (pMWs) on the paralyzed side, a minimal glottic gap <3 mm seen at the first postoperative VLS, age ≤50 years, and surgery duration ≤120 minutes were associated factors for a complete recovery of nerve function. The voice parameters improved independently from recovery of the paralysis in 90% of the patients. Conclusions: For patients with a poor prognosis of a UVP, early intervention may be beneficial. Thus, predicting factors for a full recovery of vocal fold motion would be a valuable tool. In our cohort, about 60% of recoveries could have been predicted using the above-mentioned parameters. Good quality of voice was independently reached in 90% of the cases.

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Minimizing revision rates with the “Π” technique for bilateral vocal fold immobility: A new technique combining carbon dioxide and diode laser

Head & Neck ◽

10.1002/hed.24323 ◽

2015 ◽

Vol 38 (5) ◽

pp. 801-803 ◽

Cited By ~ 2

Author(s):

Petros D. Karkos ◽

Marios Stavrakas

Keyword(s):

Carbon Dioxide ◽

Diode Laser ◽

Vocal Fold ◽

New Technique ◽

Vocal Fold Immobility ◽

A New Technique ◽

Bilateral Vocal Fold Immobility

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Laser posterior ventriculocordectomy with partial arytenoidectomy for the treatment of bilateral vocal fold immobility

The Journal of Laryngology & Otology ◽

10.1258/002221503322112969 ◽

2003 ◽

Vol 117 (7) ◽

pp. 540-543 ◽

Cited By ~ 4

Author(s):

J. Shvero ◽

R. Koren ◽

Y. Stern ◽

K. Segal ◽

R. Feinmesser ◽

...

Keyword(s):

Surgical Procedures ◽

Vocal Fold ◽

Reliable Method ◽

Post Operative Period ◽

Vocal Fold Immobility ◽

Second Procedure ◽

Bilateral Vocal Fold Immobility ◽

Severe Dyspnoea

Bilateral vocal fold immobility in adduction usually creates severe dyspnoea. Many surgical procedures have been established to improve the airway insufficiency in affected patients.Over the last six years 22 patients with bilateral vocal fold immobility in our department have undergone CO2 laser posterior ventriculocordectomy with partial arytenoidectomy (PVCPA). None had dyspnoea or a disturbance in the immediate post-operative period or during follow up, which ranged from five months to six years. Only one patient required a second procedure.Laser PVCPA appears to be an effective and reliable method for the treatment of bilateral vocal fold immobility in selected patients.

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A Clinical Study through a Chart Review of Patients Who Underwent Ejnell’s Operation for Bilateral Vocal Fold Immobility

Nihon Kikan Shokudoka Gakkai Kaiho ◽

10.2468/jbes.70.265 ◽

2019 ◽

Vol 70 (4) ◽

pp. 265-272

Author(s):

Hirohiko Sugimoto ◽

Akihito Yamauchi ◽

Niro Tayama ◽

Shigeru Kikuchi

Keyword(s):

Clinical Study ◽

Vocal Fold ◽

Chart Review ◽

Vocal Fold Immobility ◽

Bilateral Vocal Fold Immobility

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TREATMENT OF SPINAL TUMORS USING CYBERKNIFE FRACTIONATED STEREOTACTIC RADIOSURGERY

Neurosurgery ◽

10.1227/01.neu.0000338072.30246.bd ◽

2009 ◽

Vol 64 (2) ◽

pp. 297-307 ◽

Cited By ~ 79

Author(s):

Gregory J. Gagnon ◽

Nadim M. Nasr ◽

Jay J. Liao ◽

Inge Molzahn ◽

David Marsh ◽

...

Keyword(s):

Quality Of Life ◽

Stereotactic Radiosurgery ◽

University Hospital ◽

Postoperative Treatment ◽

Spinal Tumors ◽

Radiation Toxicity ◽

Pain Scores ◽

Component Scores

Abstract OBJECTIVE Benign and malignant tumors of the spine significantly impair the function and quality of life of many patients. Standard treatment options, including conventional radiotherapy and surgery, are often limited by anatomic constraints and previous treatment. Image-guided stereotactic radiosurgery using the CyberKnife system (Accuray, Inc., Sunnyvale, CA) is a novel approach in the multidisciplinary management of spinal tumors. The aim of this study was to evaluate the effects of CyberKnife stereotactic radiosurgery on pain and quality-of-life outcomes of patients with spinal tumors. METHODS We conducted a prospective study of 200 patients with benign or malignant spinal tumors treated at Georgetown University Hospital between March 2002 and September 2006. Patients were treated by means of multisession stereotactic radiosurgery using the CyberKnife as initial treatment, postoperative treatment, or retreatment. Pain scores were assessed by the Visual Analog Scale, quality of life was assessed by the SF-12 survey, and neurological examinations were conducted after treatment. RESULTS Mean pain scores decreased significantly from 40.1 to 28.6 after treatment (P < 0.001) and continued to decrease over the entire 4-year follow-up period (P < 0.05). SF-12 Physical Component scores demonstrated no significant change throughout the follow-up period. Mental Component scores were significantly higher after treatment (P < 0.01), representing a quality-of-life improvement. Early side effects of radiosurgery were mild and self-limited, and no late radiation toxicity was observed. CONCLUSION CyberKnife stereotactic radiosurgery is a safe and effective modality in the treatment of patients with spinal tumors. CyberKnife offers durable pain relief and maintenance of quality of life with a very favorable side effect profile.

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