CO₂Laser endoscopic posterior partial transverse cordotomy for bilateral paralysis of the vocal fold

Abstract

The authors' data confirm the safety, ease of performance, and efficiency of the CO2 laser EPPTC in patients with bilateral vocal fold paralysis. This report also suggests that the completion of bilateral CO2 laser EPPTC statistically increases the likelihood of restoring the airway in a one-step surgical procedure.

Cordoplasty: A New Technique for Managing Bilateral Vocal Cord Paralysis and Its Comparison with Posterior Cordotomy and External Procedure in a Large Study Group

“…In our experience, we found, it's better to undercorrect the airway initially and perform a revision later if airway was found to be inadequate, as overcorrecting the airway initially will leave the patient with poor voice and reversal of overcorrection is difficult even under best circumstances [15]. The revision rate in our series of posterior cordotomy is less (12.9 %) compared to other series [4,8,23]. This is due to our technique of posterior cordotomy which extends laterally up to inner lamina of cricoid cartilage so we could achieve a wide airway while preserving integrity of opposite vocal cord.…”

“…Other causes are neurologic, viral infection, idiopathic and intubation trauma [1], oesophageal, thyroid and gastric malignancy [2], Wegener's granulomatosis, congenital and rheumatologic diseases [1,3,4].…”

“…Currently, laser posterior cordotomy is preferred option as it permits voice production with the anterior part of the vocal cord and an adequate airway through the posterior glottis [3,4,[11][12][13][14]. On the other hand, our technique of cordoplasty preserves vocal cord mucosa completely.…”

Cordectomía posterior en el tratamiento de la parálisis bilateral de cuerdas vocales. ¿Debe ser la edad una limitación en su indicación?

“…Al tratarse de un procedimiento corto, con pocos riesgos y baja morbilidad asociada, puede repetirse en caso de resultados no satisfactorios, procediéndose a realizar un desbridamiento de la intervención previa realizada o completar una cordectomía bilateral algo menos agresiva en la cuerda vocal no intervenida en el primer procedimiento [3,13,26]. Esta fue la técnica realizada en uno de los pacientes de nuestra serie obteniéndose un buen resultado final (tasa de revisión del 6%, similar al del resto de series publicadas) [9][10][11][12][13][14][15][16][17]. En nuestra experiencia, para la realización de esta técnica no es necesaria la realización de una traqueotomía previa.…”

Schematization of katilmis technique for Vocal cord lateralization: how we do it?

“…All patients were graded as level 0 on the second postoperative day. With respect to its advantages, our technique (1) eliminates the need for tracheotomy, (2) does not require excision of anatomic structures and is reversible, (3) affords a better quality of life, (4) is applicable with or without tracheotomy, (5) enables lateralization of the tissues surrounding the rima as required, (6) avoids repeated operations, (7) allows reasonable phonation and sufficient respiration with a unilateral procedure, and (8) protects from possible tracheotomy complications. However, the technique has certain disadvantages such as the necessity of a 4-5 cm-long skin incision in the neck and the difficulties associated with approaching the vocal folds from outside the larynx.…”