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

Abstract

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.

Management of Bilateral Vocal Fold Paralysis: A Systematic Review

“…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).…”

“…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 .…”

Transoral CO2 laser‐modified posterior cordotomy combined with plasma ablation subtotal arytenoidectomy for bilateral vocal fold paralysis: A retrospective study

“…The purpose of BVFP treatment is to create an appropriate airway, maintain voice quality, and avoid aspiration, studies showed that posterior cordotomy was a commonly performed and effective technique with a short operation time in patients with BVFP. 3,6,8,14,15 The anterior 2/3 of the vocal fold is membranous, which is mainly responsible for vocal functions, and the posterior 1/3 is the cartilaginous part, the main function of which is respiration. Posterior cordotomy preserves the membranous part of the vocal fold and enlarges the cartilaginous glottis to minimise the impact on vocal function.…”

“…Posterior cordotomy preserves the membranous part of the vocal fold and enlarges the cartilaginous glottis to minimise the impact on vocal function. 16 However, a revision operation is frequently required in patients with posterior cordotomy, 3,6,8,17 the possible reason is granulation tissue and scar tissue will first fill the cordotomy defect. Segas et al 18 reported that the respiratory success rate of posterior cordotomy is 50%-68% in the first procedure, and 90%-100% in the second procedure, and partial arytenoidectomy or its combination with posterior cordectomy indicated an even higher rate of successful decannulation.…”

“…has a significant impact on appearance, causing psychosocial and emotional distress, and reducing the quality of life. Nowadays, various types of surgery for opening the glottis have been reported, including arytenoidectomy, 4,6,7 posterior cordotomy, 3,8 laterofixation, 9 micro laryngeal posterior glottoplasty, 10 and selective reinnervation. 11 However, there are currently no standardised treatment approaches for BVFP.…”