Total and Partial Laser Arytenoidectomy for Bilateral Vocal Fold Paralysis

Abstract

Introduction. Treatment for bilateral vocal fold paralysis (BVFP) has evolved from external irreversible procedures to endolaryngeal laser surgery with greater focus on anatomic and functional preservation. Since the introduction of endolaryngeal laser arytenoidectomy, certain modifications have been described, such as partial resection procedures and mucosa sparing techniques as opposed to total arytenoidectomy. Discussion. The primary outcome measure in studies on BVFP treatment using total or partial arytenoidectomy is avoidance of tracheotomy or decannulation and reported success ranges between 90 and 100% in this regard. Phonation is invariably affected and arytenoidectomy worsens both aerodynamic and acoustic vocal properties. Recent reports indicate that partial and total arytenoidectomies have similar outcome in respect to phonation and swallowing. We use CO2 laser assisted partial arytenoidectomy with a posteromedially based mucosal flap for primary cases and reserve total arytenoidectomy for revision. Lateral suturing of preserved mucosa provides tension on the vocal fold leading to better voice and leaves no raw surgical field to unpredictable scarring or granulation. Conclusion. Arytenoidectomy as a permanent static procedure remains a traditional yet sound choice in the treatment of BVFP. Laser dissection provides a precise dissection in a narrow surgical field and the possibility to perform partial arytenoidectomy.

Preliminary Evaluation of Thulium Doped Fiber Laser in Pig Model of Liver Surgery

“…Currently, medical laser devices are widely used not only in ophthalmology, but also in laryngology, dermatology, urology, oncology, and surgery, and the number of procedures performed with lasers continually grows. Several types of lasers are used in soft tissue surgery, inter alia carbon dioxide (CO 2 ), neodymium-doped yttrium aluminum garnet (Nd:YAG), and diode lasers [ 8 – 12 ]. Thulium doped fiber (Tm:fiber) lasers with the wavelength close to 2000 nm which corresponds to peak absorption of water are potentially promising tools in surgery, characterized by high efficiency and minimal thermal damage of the surrounding tissues [ 13 ].…”

Laser Partial Arytenoidectomy as an Office Procedure

“…This preliminary report of partial arytenoidectomy under local anesthesia concurs the wide emerging frontier of office-based laryngology practice commonly performed for benign and premalignant mucosal lesions. [15][16][17][18][19][20] The main advantage of office-based laser arytenoidectomy, similar to other officebased procedures, includes sparing the patient the risk of general anesthesia and the morbidity associated with suspension microlaryngoscopy, namely tongue paresthesia, tooth injury, and inadvertent mucosal injury to the pharyngeal mucosa. From the physician's perspective, the operating field is in its neutral position and the surgical time is managed more efficiently.…”

“…Anchoring the sutures of the vocal ligament to the posterior glottis help maintained tension within the vocal fold. 17 All the aforementioned procedures are performed in the operating room while the patient is under general anesthesia. This preliminary report of partial arytenoidectomy under local anesthesia concurs the wide emerging frontier of office-based laryngology practice commonly performed for benign and premalignant mucosal lesions.…”

Surgical Options for Pediatric Bilateral Vocal Cord Palsy: State of the Art

“…A surgical revision may be often necessary both post arytenoidectomy than post posterior cordotomy for the presence of scar tissue or granulations, but the decannulation rate is high (27)(28)(29).…”