The surgical treatment of unilateral vocal cord paralysis (UVCP): qualitative review analysis and meta-analysis study

Granato, F.; Martelli, Federica; Comini, Lara Valentina; Luparello, Paolo; Coscarelli, Salvatore; Seac, O Le; Carucci, Silvia; Graziani, P; Santoro, Roberto; Alderotti, Giammarco; Barillari, Maria Rosaria; Mannelli, Giuditta

doi:10.1007/s00405-019-05587-2

Cited by 21 publications

(16 citation statements)

References 48 publications

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“…The vast majority of studies, conducted in patients with paralysis, showed improvement in dysphonia and dysphagia after treatments such as external thyroplasty or injection laryngoplasty 12,22‐27 . In our study, we observed a 14.6% failure rate at 1 year and 20% at 3 years in patients presenting with a paralysis, whereas a 25% failure rate is usually reported in the literature 22,28 . Moreover, most studies reported a follow‐up ranging from 5 to 9 months, 22,28 although our results suggest that treatment failure may occur several years later.…”

Section: Discussioncontrasting

confidence: 43%

“…In our study, we observed a 14.6% failure rate at 1 year and 20% at 3 years in patients presenting with a paralysis, whereas a 25% failure rate is usually reported in the literature 22,28 . Moreover, most studies reported a follow‐up ranging from 5 to 9 months, 22,28 although our results suggest that treatment failure may occur several years later. Moreover, we found that patients with paralysis had a lower risk of treatment failure than those with ankylosis.…”

Section: Discussioncontrasting

confidence: 41%

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Characteristics, natural evolution and surgical treatment outcomes of unilateral laryngeal paralysis versus ankylosis: A longitudinal cohort study

Lisan

Couineau

Laccourreye

2021

Clinical Otolaryngology

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Aims Although unilateral laryngeal immobility (ULI) can results from paralysis or ankylosis of the cricoarytenoid joint, no comparative study exists to date. Aim of this study was to compare clinical features, aetiologies, spontaneous recovery and evolution after surgical treatment of ULI according to its mechanism. Methodology Longitudinal observational cohort study between 1992 and 2017 in a tertiary care referral centre and university teaching hospital. All adult patients with isolated ULI were included. Presenting symptoms and demographic data were recorded at baseline. During follow‐up, natural recovery and, if a surgical treatment was performed, treatment failure rate were noted. Results 994 patients were included, 56.4% of male and with a mean age of 58 years. Overall, 91% had paralysis and 9% had ankylosis. Dysphonia was the main symptom in both groups (>96%). Dyspnoea was more frequent in patients with ankylosis (26.1% vs 4.2% in those with paralysis) whereas dysphagia was more frequent in those with paralysis (31.1% vs 20% in those with ankylosis). With a mean follow‐up of 2.3 years (±5.1), spontaneous recovery did not differ according to ULI’s aetiology (hazard ratio 1.43, 95% confidence interval 0.85‐2.40). Overall, 37.1% underwent a surgical treatment, and paralysis was associated with a lower odd of treatment failure (hazard ratio 0.27, 95% confidence interval 0.10‐0.70) over a mean follow‐up of 3.1 years (±4.1). Conclusion ULI resulting from paralysis or ankylosis differ in their symptoms and responses to surgical treatment, whereas natural evolution was similar.

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Section: Discussioncontrasting

confidence: 43%

Section: Discussioncontrasting

confidence: 41%

Characteristics, natural evolution and surgical treatment outcomes of unilateral laryngeal paralysis versus ankylosis: A longitudinal cohort study

Lisan

Couineau

Laccourreye

2021

Clinical Otolaryngology

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“…The closure of the anterior commissure can be relatively easily restored by a variety of injected materials or implants 9 . However, considering the complex movement of the arytenoid cartilage, 46–49 restoring optimal closure of the respiratory glottis in patients with UVFP is a more complicated issue.…”

Section: Discussionmentioning

confidence: 99%

“…In general, the widespread vocal fold medialization techniques for the treatment of persistent UVFP include injection laryngoplasty (ILP), laryngeal framework surgery (LFS), and arytenoid adduction (AA). However, none of these procedures has been shown to be superior over the others, 8,9 and each of these techniques has a different effect on the anterior and posterior commissure. ILP and LFS are optimal solutions for anterior closing insufficiency, whereas AA surgeries are particularly suitable for correcting pronounced posterior glottic chinks 10–13 .…”

Section: Introductionmentioning

confidence: 99%

A Novel Endoscopic Arytenoid Medialization for Unilateral Vocal Fold Paralysis

et al. 2020

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Objectives/Hypothesis Arytenoid adduction (AA) has been indicated for unilateral vocal fold paralysis (UVFP) patients with vertical vocal fold height mismatch and/or large posterior glottic gaps that are unable to be adequately addressed by anterior medialization techniques. Although AA offers several advantages over other methods, it is technically challenging and involves significant laryngeal manipulation of the cricoarytenoid joint. A novel, minimally invasive endoscopic arytenoid medialization technique is presented for the closure of the posterior commissure. Study Design Prospective case series. Methods Seventeen consecutive patients were diagnosed and treated with unilateral endoscopic arytenoid medialization (EAM) combined with injection laryngoplasty because of unilateral vocal fold paralysis. Jitter, shimmer, harmonics‐to‐noise ratio (HNR), maximum phonation time (MPT), fundamental frequency (F0), Voice Handicap Index (VHI), peak inspiratory flow (PIF), and quality of life (QoL) were evaluated preoperatively, 1 month, and 1 year after EAM. Results Jitter, shimmer, HNR, and MPT significantly improved and remained stable 1 year after the intervention. F0 and PIF remained unchanged. Significant improvements in VHI and QoL demonstrated patient satisfaction with voicing and respiratory functions. Conclusions Endoscopic arytenoid medialization is a quick, minimally invasive solution for unilateral vocal fold paralysis. With simultaneous augmentation of the vocal fold, it provides a complete glottic closure along the entire vocal fold in UVFP patients. Level of Evidence 4 Laryngoscope, 131:E903–E910, 2021

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“…The third main symptom is dyspnea. Unlike bilateral paralysis, this is a rare symptom in UVFP that is reported by less than 3% of patients ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

Autologous Fat Augmentation in The Treatment of Unilateral Vocal Fold Paralysis – A 15-Year Experience in a Single Institution

Prstačić

Slipac

Ivanović

et al. 2020

ACC

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SUMMARY Autologous fat vocal fold augmentation is a widespread surgical procedure that aims to repair glottal incompetence in patients with unilateral vocal fold paralysis (UVFP). However, there are some concerns in the literature about the long-term results of this technique. At the ENT Department of the Zagreb University Hospital Centre, this technique has been in use for more than 15 years, and a retrospective medical chart review was conducted from June 2005 to November 2019. Overall, 78 patients with UVFP met the inclusion criteria for enrolment in the study. All patients underwent at least one preoperative and two postoperative voice assessments, one early (within 3 months from surgery) and one late (at least 1 year after surgery). All tested voice outcome parameters (maximum phonation time (MPT), jitter, shimmer, noise-to-harmonic ratio (NHR)) significantly improved after surgery, both early and late postoperatively (p<0.001). The reoperation rate was only 10.3% (8/78), with the majority of patients in our series experiencing long-term benefits from this surgical procedure. According to the results of our study, autologous fat vocal fold augmentation appears to be a highly useful and effective surgical technique with long-lasting results in the majority of patients suffering from UVFP.

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The surgical treatment of unilateral vocal cord paralysis (UVCP): qualitative review analysis and meta-analysis study

Cited by 21 publications

References 48 publications

Characteristics, natural evolution and surgical treatment outcomes of unilateral laryngeal paralysis versus ankylosis: A longitudinal cohort study

Characteristics, natural evolution and surgical treatment outcomes of unilateral laryngeal paralysis versus ankylosis: A longitudinal cohort study

A Novel Endoscopic Arytenoid Medialization for Unilateral Vocal Fold Paralysis

Autologous Fat Augmentation in The Treatment of Unilateral Vocal Fold Paralysis – A 15-Year Experience in a Single Institution

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