Unilateral transverse cordotomy for bilateral abductor vocal fold immobility

Abstract

In patients with bilateral abductor vocal fold immobility, unilateral transverse cordotomy results in improved dyspnoea with either no voice change or only slight worsening. This is a more conservative procedure than bilateral transverse cordotomy, with the potential for better preservation of voice and breath support.

Surgical management of bilateral vocal fold paralysis: A cost‐effectiveness comparison of two treatments

“…Rapid healing of the vocal fold and granulation tissue can cause upper airway obstruction, necessitating revision surgery. When summed across published studies, the overall rate for revision surgery after cordotomy or arytenoidectomy was 16.1%, with a range from 0.0% to 27.3% . In our model, if the revision rate were to rise to 27.2%, tracheostomy and endoscopic management would be equivalently cost‐effective.…”

“…When the utility of tracheostomy was increased to 0.867, or when the utility of dysphonia was decreased to 0.874, the strategies became equivalent in cost‐effectiveness. Importantly, the endoscopic strategy had equivalent cost‐effectiveness to tracheostomy if the rate of reoperation reached 27.2%, near the highest reported rate in the literature of 27.3% . When long‐term costs are incorporated, the model was insensitive to both cost and utility, as tracheostomy was dominated.…”

“…Probabilities were derived from published literature (Table ). For endoscopic management, the highest level of evidence consisted primarily of retrospective reviews, due to the rarity of BVFP; several trials were prospective, and one was multicenter . For tracheostomy, several meta‐analyses were available, as were several studies with large, retrospective, nonoverlapping cohorts .…”

“…Importantly, the endoscopic strategy had equivalent cost-effectiveness to tracheostomy if the rate of reoperation reached 27.2%, near the highest reported rate in the literature of 27.3%. 2,[8][9][10][11][12][14][15][16]19 When long-term costs are incorporated, the model was insensitive to both cost and utility, as tracheostomy was dominated.…”

Endoscopic Posterior Cordotomy with Microdissection Radiofrequency Electrodes for Bilateral Vocal Cord Paralysis

“…5 Unfortunately, we measured exercise capacity, not respiratory function, in our patients. All our patients confirmed better exercise tolerance and acceptable voice after the surgery.…”