Effect of Unilateral Cordotomy on Perception of Dysphagia

Abstract

Objectives: CO2 laser medial transverse cordotomy is a permanent static procedure performed to achieve adequate functional airway in cases of posterior glottic stenosis and bilateral vocal fold paralysis. Although it is the preferred method to manage long-term bilateral vocal fold immobility, it is widely believed that cordotomy has the potential to cause aspiration. The minimal existing data on the effect surgical enlargement of the glottic airway on swallowing function is heterogeneous. Through investigation of dysphagia after cordotomy, we hope to better understand the influence of glottic function and its role in dysphagia. The Eating Assessment Tool (EAT-10), is a validated dysphagia symptom-specific outcome measure. We hypothesized that EAT-10 scores would not change after CO2 laser cordotomy despite causing glottic insufficiency. Methods: Retrospective review was performed on sequential patients having undergone unilateral CO2 laser cordotomy with complete pre- and postoperative EAT-10 questionnaire data available for evaluation. Results: Fifteen patients were available for analysis; 10 patients underwent primary unilateral medial transverse cordotomy, 5 patients underwent revision cordotomy, and 20 unique procedures were included in the dataset. The median EAT-10 score during the visit prior to surgery was 3.5, whereas the post-surgery median score was 2. Furthermore, the median difference of 0 was statistically non-significant ( P = .91). Conclusion: CO2 laser cordotomy does not contribute to patient-reported dysphagia despite creating glottic incompetence. This suggests vocal fold apposition may play a less significant role in normal swallowing function than widely believed.

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

“…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. A number of different scales (i.e.…”

“…Furthermore, is evident that laryngeal sphincteric function is the result of a more complex physiologic mechanism, wherein glottic closure by TA muscles contraction is only a part of the entire process. Consequently, if the approximation of false vocal folds and arytenoids to epiglottic petiole is restored, airway protection may still be guaranteed [ 29 ]. However, to ensure maintenance of sphincteric mechanisms, it is of crucial importance to preserve at least the postero-lateral part of the arytenoid to allow the anatomical integrity of the hypopharyngo-laryngeal wall, thereby minimizing the risk of swallowing disorders [ 36 , 37 ].…”

Impact of Patient Factors and Management Strategies on Outcomes After Transverse Posterior Cordotomy

“…However, there were no major complications and no revision procedures or tracheotomies were required 8 . With regard to dysphagia, a recent study by Conklin et al found no statistically significant differences in Eating Assessment Tool‐10 scores pre‐ and postoperatively in 15 patients undergoing unilateral CO 2 laser cordotomy 9 …”

Unilateral Cordotomy: A Systematic Review of Efficacy and Outcomes

“…7 The use of static ablative procedures such as posterior cordotomy has long been thought to improve airway caliber at the expense of phonation and, in some cases, deglutition. 8 Unilateral cordotomy has been demonstrated to successfully improve respiratory function and alleviate obstruction at the level of the glottis. 8 However, there are reports of long-term tracheostomy dependence and the need for revision ablative procedures including arytenoidectomy and contralateral cordotomy.…”

“…8 Unilateral cordotomy has been demonstrated to successfully improve respiratory function and alleviate obstruction at the level of the glottis. 8 However, there are reports of long-term tracheostomy dependence and the need for revision ablative procedures including arytenoidectomy and contralateral cordotomy. Given the rarity of BVFI, most reports regarding unilateral cordotomy are single-institution studies with limited sample sizes.…”