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

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.

[1]  O. Kleinsasser,et al.  Endolaryngeale Arytaenoidektomie und submuköse partielle Chordektomie bei bilateralen Stimmlippenlähmungen , 1981 .

[2]  H. Kashima.  Bilateral Vocal Fold Motion Impairment: Pathophysiology and Management by Transverse Cordotomy , 1991, The Annals of otology, rhinology, and laryngology.

[3]  H. Tucker.  Long-Term Results of Nerve-Muscle Pedicle Reinnervation for Laryngeal Paralysis , 1989, The Annals of otology, rhinology, and laryngology.

[4]  G. Woodson.  Configuration of the glottis in laryngeal paralysis. I: Clinical study , 1993, The Laryngoscope.

[5]  D Michaelis,et al.  Selection and combination of acoustic features for the description of pathologic voices. , 1998, The Journal of the Acoustical Society of America.

[6]  D. Woodman,et al.  Bilateral Abductor Paralysis , 1976, The Annals of otology, rhinology, and laryngology.

[7]  G. Lichtenberger.  Reversible immediate and definitive lateralization of paralyzed vocal cords , 1999, European Archives of Oto-Rhino-Laryngology.

[8]  Petra Ambrosch,et al.  Assessment of irregular voices after total and laser surgical partial laryngectomy. , 2003, Archives of otolaryngology--head & neck surgery.

[9]  P. Flexon,et al.  Electrophysiologic nerve stimulation for identifying the recurrent laryngeal nerve in thyroid surgery: review of 70 consecutive thyroid surgeries. , 1998, The American surgeon.

[10]  R. Crumley.  Endoscopic Laser Medial Arytenoidectomy for Airway Management in Bilateral Laryngeal Paralysis , 1993, The Annals of otology, rhinology, and laryngology.

[11]  W. Thumfart,et al.  Cordectomy versus Arytenoidectomy in the Management of Bilateral Vocal Cord Paralysis , 1994, The Annals of otology, rhinology, and laryngology.

[12]  L. Holinger,et al.  Etiology of Bilateral Abductor Vocal Cord Paralysis , 1976, The Annals of otology, rhinology, and laryngology.

[13]  M. Remacle,et al.  Subtotal Carbon Dioxide Laser Arytenoidectomy by Endoscopic Approach for Treatment of Bilateral Cord Immobility in Adduction , 1996, The Annals of otology, rhinology, and laryngology.

[14]  R. Crumley.  Laryngeal Synkinesis: Its Significance to the Laryngologist , 1989, The Annals of otology, rhinology, and laryngology.

[15]  F. Stucker,et al.  Evaluation of bilateral vocal fold dysfunction: paralysis versus fixation, superior versus recurrent, and distal versus proximal to the laryngeal nerves. , 1997, American journal of otolaryngology.

[16]  Z. Szmeja,et al.  Laser arytenoidectomy in the treatment of bilateral vocal cord paralysis , 1999, European Archives of Oto-Rhino-Laryngology.

[17]  W. Shockley,et al.  Transient Vocal Fold Immobility , 1998, The Annals of otology, rhinology, and laryngology.

[18]  H. B. Neel,et al.  Evaluation and Treatment of the Unilateral Paralyzed Vocal Fold , 1994, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[19]  H. Tucker.  Human laryngeal reinnervation , 1976, The Laryngoscope.

[20]  L. Rovó,et al.  “Early” vocal cord laterofixation for the treatment of bilateral vocal cord immobility , 2001, European Archives of Oto-Rhino-Laryngology.

[21]  H. Kashima,et al.  Carbon Dioxide Laser Posterior Cordectomy for Treatment of Bilateral Vocal Cord Paralysis , 1989, The Annals of otology, rhinology, and laryngology.

[22]  H. Eckel,et al.  Management of Bilateral Arytenoid Cartilage Fixation versus Recurrent Laryngeal Nerve Paralysis , 2003, The Annals of otology, rhinology, and laryngology.

[23]  G. Schmidt,et al.  Isolierte reinnervation der abduktionsmuskulatur des stimmbandes , 2004, Archiv für klinische und experimentelle Ohren-, Nasen- und Kehlkopfheilkunde.

[24]  I. Månsson,et al.  A simple operation for bilateral vocal cord paralysis , 1984, The Laryngoscope.

[25]  P. Aluffi,et al.  CO2 laser posterior ventriculocordectomy for the treatment of bilateral vocal cord paralysis , 1999, European Archives of Oto-Rhino-Laryngology.

[26]  O. Pedersen,et al.  Wave-speed-determined flow limitation at peak flow in normal and asthmatic subjects. , 1997, Journal of applied physiology.

[27]  M. Br,et al.  Laryngeal electromyography in the diagnosis of laryngeal nerve injuries , 1990 .

[28]  Petra Ambrosch,et al.  Endoscopic Laser Surgery of the Upper Aerodigestive Tract: With Special Emphasis on Cancer Surgery , 2000 .

[29]  H. Rudert,et al.  Die modifizierte posteriore Chordektomie nach Dennis und Kashima bei der Behandlung beidseitiger Rekurrensparesen* , 1998 .

[30]  D Michaelis,et al.  Acoustic voice analysis by means of the hoarseness diagram. , 2000, Journal of speech, language, and hearing research : JSLHR.