Vocal and ventricular fold lateralization using crossing sutures with the thyroplasty window technique for bilateral vocal fold immobility: long-term results

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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Subtotal Carbon Dioxide Laser Arytenoidectomy for the Treatment of Bilateral Vocal Fold Immobility: Long-Term Results

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940511400206 ◽

2005 ◽

Vol 114 (2) ◽

pp. 115-121 ◽

Cited By ~ 23

Author(s):

Isabelle Plouin-Gaudon ◽

Jacques Jamart ◽

Georges Lawson ◽

Marc Remacle

Keyword(s):

Carbon Dioxide ◽

Vocal Fold ◽

Carbon Dioxide Laser ◽

Long Term Results ◽

Median Frequency ◽

Maximum Phonation Time ◽

Vocal Fold Immobility ◽

The Mean ◽

Risk Of Aspiration ◽

Bilateral Vocal Fold Immobility

Sixty-nine patients underwent subtotal carbon dioxide laser arytenoidectomy for treatment of bilateral vocal fold immobility between 1985 and 2000. The population included 69 patients whose mean age was 56 years (SD, 16 years; range, 11 to 82 years). The mean follow-up was 50 months (SD, 44 months; range, 1 to 181 months). The overall postoperative peak expiratory/peak inspiratory flow ratio (normal value, 1) significantly improved (closer to 1; p = .0036). Voice analyses were also undertaken for 27 patients, almost exclusively after operation, given the context of initial emergency. The maximum phonation time averaged 6.57 seconds (median, 6 seconds). The phonation quotient remained high, with a mean of 503 (median, 440), and the mean conversational voice intensity remained around 59 dB. The median frequency analysis type was 3. The advantage of subtotal arytenoidectomy lies in the fact that it maintains a certain degree of rigidity along the posterior limit of the arytenoid frame, preventing inward collapse of the mucosa and thus lowering the risk of aspiration.

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Endoscopic radiosurgical posterior transverse cordotomy for bilateral median vocal fold immobility

The Journal of Laryngology & Otology ◽

10.1258/002221504322927973 ◽

2004 ◽

Vol 118 (3) ◽

pp. 202-206 ◽

Cited By ~ 4

Author(s):

Sayed Elsherief ◽

Mohamed Nasser Elsheikh

Keyword(s):

Vocal Fold ◽

Acoustic Analysis ◽

Voice Quality ◽

Vocal Folds ◽

Management Approach ◽

Significant Difference ◽

One Step ◽

Vocal Fold Immobility ◽

Bilateral Vocal Fold Immobility

The objectives in treatment of bilateral vocal fold immobility (BVFI) are to achieve adequate airway, preservation of voice quality and laryngeal competence. The present prospective study was designed to evaluate precisely the efficiency and long-term clinical outcome in a series of 13 patients with irreversible BVFI, consecutively managed with endoscopic radiosurgical posterior transverse cordotomy (ERPTC). The operation was performed endoscopically using an Ellman Radiosurgical Instrument and a specially designed electrode. Pre- and post-operative inspiratory function measurements and acoustical vocal analysis were conducted on the patients and were tested for potential statistical relation to successful rehabilitation of the airway. One-step, successful restoration of the airway was achieved in all patients. The post-operative improvement of spirometric values was statistically significant (p < 0.0001), and during the follow-up period of (six to 30) months, airway stability was demonstrated in all patients. In terms of acoustic analysis a non-significant difference was found between pre- and post-operative vocal functions (p > 0.05). This management approach offers an alternative to laser procedures, it provides a ’one-stage’ solution for permanent bilateral vocal fold immobility, and avoids terminal loss of voice quality. The authors’ data confirm the safety, ease of performance, and efficiency of ERPTC in patients with bilateral immobile vocal folds.

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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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Laryngeal Framework Surgery in the Management of Spasmodic Dysphonia

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948909800111 ◽

1989 ◽

Vol 98 (1) ◽

pp. 52-54 ◽

Cited By ~ 34

Author(s):

Harvey M. Tucker

Keyword(s):

Vocal Fold ◽

Vocal Folds ◽

Long Term Results ◽

Spasmodic Dysphonia ◽

Management Problem ◽

Cure Rate ◽

Adductor Spasmodic Dysphonia ◽

Laryngeal Framework Surgery ◽

Selective Lysis

Spasmodic dysphonia continues to be a management problem for otolaryngologists. Selective lysis of the recurrent laryngeal nerve has been useful in the management of this disease. Reported long-term results, however, reveal that spasm recurs in approximately 40% to 50% of initially successful patients in spite of persistence of the unilateral vocal fold paralysis. Although some of these failures can be recaptured with subsequent laser surgery, the overall “cure” rate does not exceed 70%, even in the best hands. The contributions of Isshiki, LeJeune, and Tucker have demonstrated that tension in the vocal folds can be adjusted by laryngeal framework surgery. Experience with 16 patients suffering from adductor spasmodic dysphonia suggests that laryngeal framework surgery is useful in the management of this disorder.

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