Objectives: After bilateral vocal cord paralysis, the consequent para.median position u s ually necessitates tracheostomy for at least 6 months, when the paralysis is potentially reversible. In the present study a reversible ndoscopic vocal cord laterofixation procedure was used instead of tracheotomy. Study Design: Prospective study of 15 consecutive patients aged 33 to 73 years who suffered bilateral recurrent laryngeal nerve paralysis after thyroid surgery. Methods: The op ration w as performed endoscopically with a special endo-extralaryngeal needle carrier instrument. Two ends of a monofilament nonresorbable thread were passed above and under the posterior third of the vocal cord and knotted on the prelaryngeal muscles, permitting the creation of an abducted vocal cord position. If movement of one or both vocal cords recovered, the s uture was removed. Regular spirometric measurements and radiological aspiration tests were conducted on the patients. ResuUs: During the follow-up period of S to 40 months, airway stability was demonstrated in all but one patient. After the repeated lateralization procedure, this patient's breathing improved. Partial or complete vocal cord recovery was observed in eight patients. In six patients further voice improvement was achieved when the threads were removed after vocal cord medialization or recovery. Mild postoperative aspirations ceased in the first postoperative days. Conclusions: Tb.is management approach offers an alternative to tracheostomy in the early period of paralysis, avoids terminal loss of voice quality, and provides a "onestage" solution for permanent bilateral recurrent nerve ittjuries. Key Words: Airway complication, recurrent n erve iajury, minimally invasive surgery, vocal cord laterofixation, thyroid surgery.

The concept of "early" laterofixation satisfies the important criteria: it can provide an immediate and long-lasting adequate airway, and it can be considered potentially reversible from the point of view of laryngeal functions. Thus the procedure is a reliable primary treatment for bilateral VCI.

Posterior glottic stenosis most commonly results from prolonged endotracheal intubation. The tube causes decubitus and perichondritis with a consequent scar tissue formation in the posterior commissure that often limits the abduction of the vocal cords. Many different surgical methods are known for the treatment, but in most cases temporary tracheostomy is required. We recommend a minimally invasive method to avoid tracheostomy, which is a very inconvenient state for the patient. The scar of the posterior commissure is excised endoscopically with the CO2 laser, and a modification of the endoextralaryngeal vocal cord laterofixation described by Lichtenberger is used to lateralize 1 or both vocal cords until the posterior commissure is completely reepithelialized. In this article we report on the first 5 cases. All patients had satisfactory airways immediately after the laterofixation procedure, which proved to be stable later on as well. In the cases of moderate stenosis, further scarring was prevented, and after the healing of the mucosa in the posterior glottic area, the laterofixation sutures were removed. The vocal cord mobility was recovered in the cases in which the cricoarytenoid joint was not fixed. In 1 case of severe stenosis (bilateral cricoarytenoid joint fixation), the procedure yielded only partial improvement.

Reinforced Gore-Tex prosth eses were implanted into the t rac hea, above t he bif urcatio n, in 11 dogs. Th e firs t 3 anima ls d ied wit hi n a few da vs. du e to a n ina p propriate sur gical tec hniq ue. The remai ning animals were subjected to an adeqcate surgical proc ed ure and all su rvived-for a per iod 01 at least several mo nths, except one which died of an esc phaqo-t racheal fistula after 6 weeks. lngrowth of respiratory epit he lium into the prosth eses was obse rved 5 to 7 weeks postoperat ively.