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

Abstract

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.

Management of Bilateral Vocal Fold Paralysis: A Systematic Review

“…In case of insufficient benefit from unilateral posterior cordotomy, bilateral posterior cordotomy could be considered. Many authors proposed bilateral posterior cordotomy as the first procedure for patients with BVFP 35‐38,73‐75 . The mean decannulation rate of bilateral posterior transverse cordotomy was 76.6% (range: 0%‐100%).…”

“…A study reported improvements of VHI 516 days after the procedure 38 . The swallowing improved 73 or did not change from pre‐ to postsurgery 37 . The revision rate of bilateral posterior cordotomy ranged from 0% to 46.7% and was mostly related to the management of granuloma, 38 or fibrosis/scaring of the sectioned vocal cord 74 …”

“…Many authors proposed bilateral posterior cordotomy as the first procedure for patients with BVFP. [35][36][37][38][73][74][75] The mean decannulation rate of bilateral posterior transverse cordotomy was 76.6% (range: 0%-100%). The decannulation rate of bilateral cordotomy appears as lower than the mean decannulation rate of unilateral posterior cordotomy (95.1%) but the populations included in studies were substantially different.…”

“…Most authors reported that the patient-reported or physician perception of dyspnea, 35,36,38,61 MPT, 35,61 forced vital capacity, 35 PIF, FEV1, 35,37,61 VO 2 max, 35 improved postsurgery. The voice quality findings were more controversial with worsening (VHI, 35 grade, roughness, breathiness, asthenia, strain 35,37 ) or unchanged 73 voice quality outcomes after surgery. A study reported improvements of VHI 516 days after the procedure.…”

Medical Applications of Diode Lasers: Pulsed versus Continuous Wave (cw) Regime

“…On the other hand, patients with contact granuloma, subglottic stenosis and tracheal lesions showed partial remission with laser surgery. Recently, Karkos et al [ 30 , 31 ] demonstrated the efficacy of a new ‘‘Π’’ surgical technique (using 980 nm DL laser, 4–9 W) postoperatively to improve quality of voice and swallowing. It was proven that the 980 nm diode laser appears to be safe and ‘‘friendly’’.…”