Arytenoidcordectomy for bilateral vocal cord paralysis: Primary and revision procedure

Abstract

Background: Definitive enlargement of the glottis with preservation of adequate voicing in patients with bilateral recurrent nerve paralysis remains a surgical challenge especially in patients with previous unsuccessful surgery. Study design: Report of a novel surgical technique for glottis enlargement and presentation of midterm results. Methods: Four adult patients with bilateral recurrent nerve paralysis were subjected to submucosal arytenoidcordectomy through a thyreofissure approach with ventricular folds transposition and long-term translaryngeal stenting. Two of them had had previous surgeries at the glottic level. Preoperative data as well as postoperative functional results are reviewed. Follow-up ranged from 8 to 28 months. Results: In all patients tracheostomy closure was achieved. Midterm follow-up revealed stable airway, adequate for the patients' routine physical activities. Postoperatively patients phonated with the ventricular folds and the resulting voice quality was good. Conclusions: We describe a novel approach for management of impaired airway because of bilateral recurrent nerve paralysis and/or stenosis. It comprises intralaryngeal soft tissue resection, enlargement of the cartilaginous framework of the larynx and long-term translaryngeal stenting. The surgical approach described here proved to be successful both in patients with simple bilateral vocal fold motion impairment and in those, who have been already unsuccessfully treated with other surgery. Nevertheless the technique should be regarded as an option only in complicated revision cases, rather than a primary intervention in bilateral vocal fold paralysis.