Functional results of endoscopic arytenoid abduction lateropexy for bilateral vocal fold palsy

Rovó, László; Matievics, Vera; Sztanó, Balázs; Szakács, László; Pálinkó, Dóra; Wootten, Christopher T.; Pfiszterer, Péter; Tóbiás, Zoltán; Bach, Ádám

doi:10.1007/s00405-021-07199-1

Cited by 6 publications

(10 citation statements)

References 44 publications

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“…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).…”

Section: Resultsmentioning

confidence: 99%

“…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 .…”

Section: Resultsmentioning

confidence: 99%

“…Chest and head and neck cancers that may lead to BVFP are related to thyroid (68.4%), 18,22 larynx (15.7%), 18 lung (5.3%), 27 esophagus (5.3%), 40 or may consist of bilateral neck metastases (5.3%). 22 The other etiologies of BVFP are congenital (1.2%), 22,27,32 infectious (postviral, 19,25 or tuberculosis 27 ), ischemic (strangulation, 0.3%), 19,24 or inflammatory (Wegener). 32 Radiation 28,33 and prolonged intubation 24,25,32,38 were suggested as potential etiologies of BVFP but authors included patients with bilateral vocal fold immobility, which may include posterior glottic stenoses.…”

Section: Etiologiesmentioning

confidence: 99%

“…Decannulation is achieved in 20% to 100% of cases depending on the surgical procedure (Table 2). 11,19,58 However, tracheotomy is associated with decreased quality of life, psychological and social problems, and requires continual postoperative care. [61][62][63] Currently, tracheotomy may be considered as an emergent surgical procedure for patients with severe dyspnea related to BVFP while awaiting recovery of movements of 1 or both vocal folds, which can take as long as 6 to 9 months postinjury.…”

Section: Tracheotomymentioning

confidence: 99%

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Management of Bilateral Vocal Fold Paralysis: A Systematic Review

Lechien,

Hans,

Mau

2023

Otolaryngol.--head neck surg.

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ObjectiveTo review the current literature about epidemiology, etiologies and surgical management of bilateral vocal fold paralysis (BVFP).Data SourcesPubMED, Scopus, and Cochrane Library.Review MethodsA systematic review of the literature on epidemiology, etiologies, and management of adult patients with BVFP was conducted through preferred reporting items for systematic reviews and meta‐analyses statements by 2 investigators.ResultsOf the 360 identified papers, 245 were screened, and of these 55 were considered for review. The majority (76.6%) of BVFP cases are iatrogenic. BVFP requires immediate tracheotomy in 36.2% of cases. Laterofixation of the vocal fold was described in 9 studies and is a cost‐effective alternative procedure to tracheotomy while awaiting potential recovery. Unilateral and bilateral posterior transverse cordotomy outcomes were reported in 9 and 7 studies, respectively. Both approaches are associated with a 95.1% decannulation rate, adequate airway volume, but voice quality worsening. Unilateral/bilateral partial arytenoidectomy data were described in 4 studies, which reported lower decannulation rate (83%) and better voice quality outcome than cordotomy. Revision rates and complications vary across studies, with complications mainly involving edema, granuloma, fibrosis, and scarring. Selective posterior cricoarytenoid reinnervation is being performed by more surgeons and should be a promising addition to the BVFP surgical armamentarium.ConclusionDepending on techniques, the management of BVFP may be associated with several degrees of airway improvements while worsened or unchanged voice quality. The heterogeneity between studies, the lack of large‐cohort controlled randomized studies and the confusion with posterior glottic stenosis limit the draw of clear conclusion about the superiority of some techniques over others.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Etiologiesmentioning

confidence: 99%

Section: Tracheotomymentioning

confidence: 99%

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Management of Bilateral Vocal Fold Paralysis: A Systematic Review

Lechien,

Hans,

Mau

2023

Otolaryngol.--head neck surg.

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“…The evolution of new surgical techniques aims to find a balance between breathing, swallowing, and vocal function. In 2010 Rovò et al [14][15][16][17] introduced a new tool for arytenoid abduction: the endolaryngeal thread guide instrument (ETGI). In 2017 and 2019, the same group employed this instrument in newborns with good results, 7,18 but the sample was limited.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Bilateral Vocal Cord Immobility: New Treatment With Preservation of Voice

et al. 2022

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ObjectivesPediatric bilateral vocal cord immobility (BVCI) represents a severe life‐threatening condition that often causes severe dyspnea. Endoscopic arytenoid lateral abduction (EALA) is a relatively new, secure, minimal‐invasive surgical technique. The present prospective observational study aims to evaluate the effects of EALA in terms of respiratory function, voice quality, and swallowing capabilities.MethodsTwenty‐one pediatric patients with BVCI underwent EALA. Eleven out of 21 patients had tracheostomy at the time of surgery. Pre and postoperative functional assessments included endoscopic evaluation, maximum phonation time, pediatric Voice Handicap Index (pVHI), GIRBAS Scale criteria, and Montreal Children's Hospital Feeding scale (MCH‐Feeding scale). peak tidal inspiratory flow or peak inspiratory flow (PIF) and number of desaturations/hour (ODI/h) were evaluated in patients without tracheostomy.ResultsPostoperative endoscopy showed glottic airway improvement in all patients. Average time for decannulation was 4.6 weeks. One patient has not yet been decannulated. No major complications occurred. In patients without tracheostomy, we observed a significant improvement of ODI/h and PIF after surgery (p < 0.05) as expected. PVHI, MCH‐Feeding scale, and GIRBAS score significantly worsened 1 month after surgical intervention (p < 0.05). One year after surgery, however, all values, except for B and A parameters of the GIRBAS score, returned to levels comparable to those preoperative.ConclusionsEALA represents a simple, safe and effective solution in pediatric patients with BVCI, avoiding tracheostomy, allowing early decannulation, preserving swallowing function, and maintaining good quality voice.Level of Evidence4 Laryngoscope, 133:2325–2332, 2023

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A Contemporary Review of Surgical Options in Laryngotracheal Stenosis

Śladowska,

Rzepakowska

2024

Indian J Otolaryngol Head Neck Surg

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Upper airway stenosis is a potentially life-threatening condition that can occur at the level of the larynx, trachea, or multiple sites. It compromises breathing, coughing up secretions or voice production. To date, a wide range of endoscopic and open procedures have been described. Different techniques involve variable decannulation times, recurrence rates or complications. Improved breathing is a major concern for each method. However, other laryngeal functions should also be maintained with optimal voice quality and swallowing function. All these features create a constant challenge for stenosis surgery and, consequently, the need to verify and improve existing methods. A literature review was performed to provide an overview of the different treatment methods utilized in particular localizations. Supraglottic stenosis has a high rate of recurrence; nevertheless, it has a better prognosis than glottic or subglottic stenosis does. In this location, endoscopic surgery is preferable because of its decreased morbidity and optimal wound healing. Glottic stenosis includes bilateral vocal fold palsy (BVFP) and anterior and posterior glottic stenosis. Endoscopic resection combined with readhesion-reducing treatment is recommended for less advanced scars. Endoscopic laterofixation is a safe and easy method to perform for BVFP when there is potential for functional recurrence. Posterior cordotomy with partial arytenoidectomy is selected for patients with persistent disease. Subglottic stenosis is graded according to the Cotton–Myer classification, and open surgical procedures are more successful than endoscopic procedures in terms of decannulation rates and disease-free recurrence periods. The current guidelines concerning the treatment of LTS are still heterogeneous and cover a wide spectrum of procedures. Consequently, the therapy should be tailored individually to the patient, and the operator should be familiar with advantages related to different approaches. Future protocol development requires the standardization of qualification criteria and the verification of respiratory, voice and swallowing results.

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Functional results of endoscopic arytenoid abduction lateropexy for bilateral vocal fold palsy

Cited by 6 publications

References 44 publications

Management of Bilateral Vocal Fold Paralysis: A Systematic Review

Management of Bilateral Vocal Fold Paralysis: A Systematic Review

Pediatric Bilateral Vocal Cord Immobility: New Treatment With Preservation of Voice

A Contemporary Review of Surgical Options in Laryngotracheal Stenosis

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