Impact of unilateral carbon dioxide laser posterior transverse cordotomy on vocal and aerodynamic parameters in bilateral vocal fold paralysis

Abstract

Unilateral carbon dioxide laser posterior transverse cordotomy is an effective procedure that results in improved dyspnoea and aerodynamic performance with some worsening of voice parameters.

Endoscopic Laser Cordotomy for Bilateral Recurrent Paralysis – Comments on a Clinical Case

“…The main purpose is to relieve the airway obstruction, because the abductor muscle function is lost. Tracheostomy assures a more efficient airway and is most frequently opted for emergencies, but has a high social impact for the patient and is hardly accepted as a long term solution 8 . Surgical techniques which approach the arytenoids and ventricles by using CO2 laser have a higher risk of postoperative granuloma and may require reintervention 9 .…”

“…After that, we evaluated the glottis aperture we decided for an unilateral endoscopic posterior cordotomy. Many studies report a temporary impairment of the voice after laser surgery 8 . In our case the patient described a comparable voice quality as before surgery.…”

“…Before endoscopic and laser technology was developed, most methods required prophylactic tracheotomy, which resulted in a poor voice. Tracheotomy remains the treatment of choice for most patients who present acute respiratory distress 7,8 . Kashima procedure or laser endoscopic posterior cordotomy, described in 1989 by Dennis and Kashima, is one of the most preferred surgical techniques as it improves the posterior glottis area.…”

“…Posterior glottis represents 50-65% of the total glottis, which explains why this approach has a better outcome on the air flow 6,9 . This procedure preserves the anterior glottis, which ensures good phonation and also has low aspiration risk 8 .…”

Laryngeal pacing for bilateral vocal fold paralysis: Voice and respiratory aspects

“…Although transoral laser surgical glottic enlargement is considered the gold standard treatment for permanent bilateral vocal fold paralysis (BVFP), the consequent improvement of the respiratory function often correlates with voice quality deterioration due to the irreversible and static modification of the vocal fold conformation . On the contrary, the dynamic restoration of the compromised vocal fold mobility would be expected to correlate with improved respiratory function without negative effects on the voice quality .…”