A comparison of two endoscopic posterior cordotomy techniques: Laser cordotomy vs diathermy‐assisted cordotomy

Öztürk, Kerem; Turhal, Göksel; Kaya, İsa; Aysel, Abdulhalim; Benzer, Murat; Ekren, Pervin Korkmaz; Akyıldız, Serdar

doi:10.1111/coa.12953

Cited by 8 publications

(12 citation statements)

References 23 publications

(52 reference statements)

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“…As previously reported, this type of surgical procedure does not require prophylactic tracheotomy, thereby minimizing post-operative morbidity and hospitalization time and improving vocal outcomes [27,28]. Our data, in line with that reported in the literature [29,30], show that CO 2 laser PC ± MPA does not negatively affect swallowing function, although it does cause wide unilateral posterior glottic incompetence, as this is the aim of the surgical procedure itself.…”

Section: Discussionsupporting

confidence: 90%

Quality of life after transoral CO2 laser posterior cordotomy with or without partial arytenoidectomy for bilateral adductor vocal cord paralysis

Filauro

Vallin

Marcenaro

et al. 2021

Eur Arch Otorhinolaryngol

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Objectives Bilateral adductor vocal cord paralysis (BAVCP) is a rare and challenging condition whose main consequence is reduction of airway patency at the glottic level, often causing respiratory distress, while vocal function tends to remain almost normal. We investigated the effect of transoral glottal widening on quality of life and decannulation rates in patients affected by BAVCP. Methods We retrospectively evaluated patients affected by BAVCP and treated by transoral CO2 posterior cordotomy with or without medial partial arytenoidectomy (PC ± MPA) at two referral centers. The primary outcome was change in quality of life, evaluated pre- and post-operatively by the ADVS, VHI-30, and EAT-10 questionnaires. Secondary outcomes were the need for retreatments and, for patients with tracheotomy, the time to decannulation. Results Thirty-three patients met selection criteria. The etiology was post-surgical in 27 cases (81.8%), idiopathic in 4 (12.1%), a trauma-related in 1 (6.0%), and to other causes in 1 (3.0%). In 22 cases (66.7%), PC was combined with MPA. A significant improvement in responses for the ADVS (p < .0001) and EAT-10 (p < .0001) was observed, whereas the VHI-30 score did not change significantly post-operatively. All nine patients with a tracheostomy were successfully decannulated within 18 months after the surgical procedure. Conclusions For patients affected by BAVCP, PC ± MPA by transoral CO2 laser microsurgery is a safe, customizable and minimally invasive treatment that can guarantee an affordable balance between quality of life in terms of phonation and swallowing and acceptable airway patency.

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Section: Discussionsupporting

confidence: 90%

Quality of life after transoral CO2 laser posterior cordotomy with or without partial arytenoidectomy for bilateral adductor vocal cord paralysis

Filauro

Vallin

Marcenaro

et al. 2021

Eur Arch Otorhinolaryngol

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“…The degree of posterior transverse cordotomy may vary based on the degree of muscle section 31 . The CO 2 laser‐assisted cordotomy is the most used approach and did not report significant respiratory or voice outcome differences than the diathermy‐assisted procedure in unilateral or bilateral posterior cordotomy 43 …”

Section: Resultsmentioning

confidence: 94%

“…Etiologies of BVCP were available in 36 papers (Table 1). 18‐54 Surgical procedures were known for a long‐time as responsible for most of the cases of BVFP. The data of studies were pooled to highlight the main etiologies of BVFP (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…The data of studies were pooled to highlight the main etiologies of BVFP (Table 1). 18‐54 Surgery (76.6%), idiopathic (6.9%), traumas (3.0%), and neurological diseases (2.5%) are the most common causes of BVFP. The surgical procedures associated with an increased risk of BVFP include thyroidectomy (97.1%), 18‐25,27,28,31‐54 esophagectomy (1.4%), 18,25,27 brain or skull base surgeries (0.7%), 28,31 tracheal or chest surgeries (0.6%), 25,48 bilateral glomus resection (0.1%), 52 and thymectomy (0.1%) 36 .…”

Section: Resultsmentioning

confidence: 99%

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Management of Bilateral Vocal Fold Paralysis: A Systematic Review

Lechien,

Hans,

Mau

2023

Otolaryngol.--head neck surg.

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ObjectiveTo review the current literature about epidemiology, etiologies and surgical management of bilateral vocal fold paralysis (BVFP).Data SourcesPubMED, Scopus, and Cochrane Library.Review MethodsA systematic review of the literature on epidemiology, etiologies, and management of adult patients with BVFP was conducted through preferred reporting items for systematic reviews and meta‐analyses statements by 2 investigators.ResultsOf the 360 identified papers, 245 were screened, and of these 55 were considered for review. The majority (76.6%) of BVFP cases are iatrogenic. BVFP requires immediate tracheotomy in 36.2% of cases. Laterofixation of the vocal fold was described in 9 studies and is a cost‐effective alternative procedure to tracheotomy while awaiting potential recovery. Unilateral and bilateral posterior transverse cordotomy outcomes were reported in 9 and 7 studies, respectively. Both approaches are associated with a 95.1% decannulation rate, adequate airway volume, but voice quality worsening. Unilateral/bilateral partial arytenoidectomy data were described in 4 studies, which reported lower decannulation rate (83%) and better voice quality outcome than cordotomy. Revision rates and complications vary across studies, with complications mainly involving edema, granuloma, fibrosis, and scarring. Selective posterior cricoarytenoid reinnervation is being performed by more surgeons and should be a promising addition to the BVFP surgical armamentarium.ConclusionDepending on techniques, the management of BVFP may be associated with several degrees of airway improvements while worsened or unchanged voice quality. The heterogeneity between studies, the lack of large‐cohort controlled randomized studies and the confusion with posterior glottic stenosis limit the draw of clear conclusion about the superiority of some techniques over others.

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“…There were no statistically significant differences in the objective voice test between both groups. 8 In another study they used radiofrequency in cut mode (15-25watt) in 11 patients to perform posterior cordotomy and reported in all an improvement in dyspnea and in exercise tolerance. Two required revision surgery for granulomas and crusting.…”

Section: Discussionmentioning

confidence: 99%

Posterior cordotomy in bilateral vocal cord paralysis

Ruggeri¹,

Latourrette²

2022

JOENTR

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Introduction: Bilateral vocal cords paralysis in adduction when it is irreversible requires treatment due to the inspiratory dyspnea that produces. Different surgical techniques can be used to increase the glottic space. Posterior cordotomy with partial arytenoidectomy improves dyspnea and is one of the most used surgeries. Objectives: To determine the resolution rate of inspiratory dyspnea or decannulation, in patients with bilateral vocal cord paralysis in adduction treated with posterior cordotomy and partial arytenoidectomy Methods: A retrospective and descriptive study was carried out by analyzing the electronic medical records of all patients who had bilateral vocal cords paralysis in adduction and were treated with posterior cordotomy and partial arytenoidectomy between March 2004 and December 2018. The result of the posterior cordotomy with partial arytenoidectomy was determined according to the decannulation rate of the patients who had tracheostomy, according to dyspnea resolution after the cordotomy and by the increase of the postoperative glottic space evidenced by endoscopy. Results: Nineteen patients were treated by bilateral vocal cord paralysis in adduction. The most frequent cause was a total thyroidectomy (9/19). Eight had a tracheostomy prior to posterior cordotomy. Seven of eight patients who had tracheostomy were able to decannulate, the rest had insufficient glottic space and did not return to control. All patients without tracheostomy (11/19) improved their inspiratory dyspnea and had no limitation for their daily life activities. Conclusions: The resolution of inspiratory dyspnea in patients with bilateral vocal cords paralysis in adduction without tracheostomy, treated with posterior cordotomy and partial arytenoidectomy was 100% (11/11). In tracheotomized patients the decannulation rate was 87,50% (7/8).

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A comparison of two endoscopic posterior cordotomy techniques: Laser cordotomy vs diathermy‐assisted cordotomy

Cited by 8 publications

References 23 publications

Quality of life after transoral CO2 laser posterior cordotomy with or without partial arytenoidectomy for bilateral adductor vocal cord paralysis

Quality of life after transoral CO2 laser posterior cordotomy with or without partial arytenoidectomy for bilateral adductor vocal cord paralysis

Management of Bilateral Vocal Fold Paralysis: A Systematic Review

Posterior cordotomy in bilateral vocal cord paralysis

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