Outcomes of CO2 laser-assisted posterior cordectomy in bilateral vocal cord paralysis in 132 cases

Abstract

The purpose of the study was to assess the role of laser-assisted posterior cordectomy in the management of patients with bilateral vocal cord paralysis. We aimed an analysis of 132 consecutive patients treated by CO2 laser posterior cordectomy, aged 38–91, 31% tracheotomized on admission. Cordectomy was performed under microlaryngoscopy using CO2 laser (Lumenis AcuPulse 40 CO2 laser, wavelength 10.6 μm, Lumenis Ltd., Yokneam, Israel). We looked at the number of laser glottic procedures necessary to achieve decannulation in tracheotomized patients and to achieve respiratory comfort in non-tracheotomized subjects and we evaluated the two groups for differences in patient characteristics. In tracheotomized patients, we also assessed factors affecting the success of decannulation and we evaluated the impact of tracheotomy on patients’ lives. Decannulation was performed in 63% of tracheotomized patients. In terms of the number of procedures, 54% (14), 19% (5), and 27% (7) tracheotomized vs. 74% (61), 24% (20), and 2% (2) non-tracheotomized subjects underwent one, two, or three procedures, respectively. In the group of tracheotomized patients who were successfully decannulated, the number of multiple laser-assisted procedures was significantly higher than in the group of non-tracheotomized subjects with respiratory comfort after treatment (p = 0.04). Advanced age (> 66 years), comorbidities (diabetes, gastroesophageal reflux disease (GERD)), multiple thyroid surgeries, and tracheotomy below the cricoid cartilage were found to decrease the likelihood of successful decannulation. Posterior cordectomy is a simple method allowing for airway improvement and decannulation in patients with bilateral vocal cord paralysis. It is less effective in tracheotomized subjects with diabetes or GERD, older than 66 years old, after two or more thyroidectomies.

Therapy of bilateral vocal fold paralysis: Real world data of an international multi-center registry

“…We showed that BVFP-related dyspnea was not significantly relieved by glottal enlargement in 5% of the patients 1 month and in 3% of the patients 3 months after surgery. The results of our registry showed that age is a significant predictor for post-treatment dyspnea, while it was not found to be reliable predictor for decannulation, which is in contradiction with the results of a previous study [10]. However, the results of our registry confirmed that older patients (≥ 65 years old) required more medical care.…”

“…We assume that this finding could be linked to the fact that procedures based on physiological abduction of the arytenoid cartilage seem to be the most effective [13]. In summary, while surgical glottal enlargement is likely to be more cost-effective than tracheostomy [14], it still show a relevant risk of revision in the 2 years following the first treatment, as also reported by Jackowska et al [10]. Thus, it is important to consider new, more physiological approaches with a potential low rate of revisions.…”

“…The largest retrospective study published so far was a monocentric and included 132 retrospectively included BVFP patients, who underwent posterior cordotomy [10]. In this study, 31% of the patients were tracheotomized before glottal enlargement.…”

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

“…Although rates of complications have been reported, there is very little in the current literature regarding how specific patient factors and perioperative management strategies may influence complication rates in patients undergoing TPC. One previous study identified GERD and diabetes mellitus (DM) as comorbidites that decreased the likelihood of decannulation in patients undergoing TPC for BVFP 13 . We found that patients with PGS had worse outcomes than those with BVFP.…”

Methods of surgical treatment of bilateral vocal fold paralysis.

“…Nevertheless, the provision of good quality of life in those patients also includes the restoration of the remaining functions of the larynx, such as phonation and swallowing. According to Jackowska et al, the most important indices of treatment effectiveness in patients with tracheostomy are the rate and time of decannulation [91]. Therefore, it seems to be of utmost importance to avert tracheostomy by the fastest possible revision of the neck in case of iatrogenic bilateral vocal fold paralysis, and to perform end-to-end anastomosis if nerve discontinuation is confirmed.…”