Current Treatment Options for Bilateral Vocal Fold Paralysis: A State-of-the-Art Review

Abstract

Vocal fold paralysis (VFP) refers to neurological causes of reduced or absent movement of one or both vocal folds. Bilateral VFP (BVFP) is characterized by inspiratory dyspnea due to narrowing of the airway at the glottic level with both vocal folds assuming a paramedian position. The primary objective of intervention for BVFP is to relieve patients’ dyspnea. Common clinical options for management include tracheostomy, arytenoidectomy and cordotomy. Other options that have been used with varying success include reinnervation techniques and botulinum toxin (Botox) injections into the vocal fold adductors. More recently, research has focused on neuromodulation, laryngeal pacing, gene therapy, and stem cell therapy. These newer approaches have the potential advantage of avoiding damage to the voicing mechanism of the larynx with an added goal of restoring some physiologic movement of the affected vocal folds. However, clinical data are scarce for these new treatment options (i.e., reinnervation and pacing), so more investigative work is needed. These areas of research are expected to provide dramatic improvements in the treatment of BVFP.

Continuous versus intermittent intraoperative neuromonitoring in complex benign thyroid surgery: A retrospective analysis and prospective follow‐up

“…If the symptoms cannot be relieved by conservative therapies, these established, safe and long‐term effective microlaryngoscopic and transcervical medialisation procedures were shown to significantly improve the voice and quality of life . While tracheostomy is still the choice in life‐threatening BVFP, subsequent implementation of surgical glottal enlargement should be considered for decannulation and closure of the tracheostoma . Alternative methods to regain respiratory functionality after BVFP onset by means of more physiological treatments include the development of laryngeal pacemakers, which have, in contrast to current surgical therapies, the potential to improve respiration while preserving voice quality …”

Endoscopic Posterior Cricoid Split With Graft in an Adult With Posterior Cricoid Fracture

“…The management of BVFI requires a balance between optimizing airway patency while simultaneously maintaining voice and swallowing function. In patients who present with severe dyspnea due to acute BVFI, tracheotomy is the gold standard treatment to establish a safe and secure airway . In less symptomatic cases of BVFI, alternate treatment options are often sought due the inherent impact on quality of life that tracheotomy carries.…”

“…In patients who present with severe dyspnea due to acute BVFI, tracheotomy is the gold standard treatment to establish a safe and secure airway. 5,7 In less symptomatic cases of BVFI, alternate treatment options are often sought due the inherent impact on quality of life that tracheotomy carries. Such alternate management options include suture lateralization, medial arytenoidectomy, and transverse cordotomy.…”

Usage of KTP laser in posterior transverse cordotomy a Sri Lankan experience

“…Numerous procedures have been described in the literature regarding treatment for abductor vocal cord palsy 2 . External and endoscopic approaches have been practiced for many decades.…”

“…External and endoscopic approaches have been practiced for many decades. CO 2 Laser usage for arytenoidectomy was described first by ossaf et al (1983) 3 and Laser cordotomy by Kashima et al (1989) 4 . Many studies had been published regarding the efficacy of CO 2 Laser, but limited data are available regarding usage of KTP Laser in posterior transverse cordotomy with promising outcomes 5,6,7 , comparable with outcomes of CO 2 Laser cordotomy.…”