Laser-assisted posterior cordotomy for bilateral vocal fold paralysis: Our experience

Virmani, Nitish; Dabholkar, Jyoti

doi:10.4103/2347-8128.182852

Cited by 5 publications

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“…One patient required re-tracheostomy after an episode of recurrent prolonged mechanical ventilation. Our rate of decannulation (100%) was similar to that reported by others (83-100%) [9][10][11] although our cohort included 42% of tracheostomydependent patients. In other series [9][10][11] the rate of tracheostomy dependent patients ranged from 7.6% to 57.1%.…”

Section: Discussionsupporting

confidence: 87%

“…Hillel et al reported that a PC may even improve voice quality in patients with bilateral vocal cord paralysis [12]. Another disadvantage of a PC is the risk of aspiration pneumonia due to the posterior glottis gap [10]. None of our patients had history of aspiration pneumonia postoperatively despite the fact that three of them reported cough on fluid intake.…”

Section: Discussionmentioning

confidence: 65%

“…This may be addressed by revision of the PC or by other glottis-widening procedures, such as suture lateralization, arytenoidectomy, or proceeding with a tracheostomy. The rate of revision of the PC varies in published series and ranges between 6-25% [3,4,[7][8][9][10][11][12][13].Only three of our patients required revision PC due to re-stenosis, and one of them eventually also required suture lateralization and partial arrytenoidectomy in order to relieve her dyspnea. In 5 patients VFI was only a part of the etiology of dyspnea.…”

Section: Discussionmentioning

confidence: 86%

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Endoscopic posterior cordotomy for treatment of dyspnea due to vocal fold immobility

et al. 2020

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Introduction: Several surgical procedures have been described for the treatment of respiratory distress secondary to vocal fold immobility (VFI), but the contribution of posterior cordotomy (PC) to tracheostomy weaning or prevention has not been studied in depth, particularly in the acute setting. The objective of this study was to show the effectiveness of PC to relieve dyspnea, prevent the need for tracheostomy, and enable decannulation in patients with VFI. Methods: We conducted a retrospective study and reviewed the medical records of all patients whose dyspnea warranted surgical intervention from January 2013 to January 2018. Data were retrieved on epidemiology, etiology, and duration of VFI, tracheostomy dependence, success in decannulation from tracheostomy or respiratory relief, number of procedures until decannulation, and complications. Results: Twelve suitable patients were identified of whom eleven had bilateral VFI and one had unilateral VFI. Five were tracheostomy-dependent. Ten patients underwent unilateral PC, and two patients underwent bilateral PC. All the patients experienced respiratory relief, eleven after a single PC and one after two PCs. All tracheostomy-dependent patients were decannulated. The mean follow-up after PC was 24.55 months during which none of the patients required a re-tracheostomy and three patients required revision of the PC. There were no surgical complications. Postoperatively, eight patients (67%) experienced a breathy voice and three patients (25%) had dysphagia for fluids. No patient had aspiration pneumonia. Conclusions: We conclude that PC is an easy, safe, and effective procedure for tracheostomy weaning and respiratory relief in patients with VFI. A revision PC may be indicated in some patients. A breathy voice is to be expected, and a few patients will experience dysphagia to fluids that may be addressed by instructing the patient to use a fluid thickener and take small sips.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 86%

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Endoscopic posterior cordotomy for treatment of dyspnea due to vocal fold immobility

et al. 2020

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“…Rao et al reported a 92% success rate in decannulation for tracheostomized patients treated with laser cordotomy combined with vocal fold lateralization [18] . Using a laser posterior cordectomy, Ferri et al [21] , Reker & Rudert [11] , and Virmani & Dabholkar [1] reported 100% decannulation within 3 to 60 days. This high success rate can be explained by the small number of cases included in the previous studies as it was 9, 6 and 4 respectively.…”

Section: Discussionmentioning

confidence: 99%

“…BVFP is a serious airway problem that could present in the form of acute respiratory insufficiency [1] . Recurrent laryngeal nerve paralysis accounts for about 25% of cases.…”

Section: Introductionmentioning

confidence: 99%

Combined Laser Posterior Cordotomy and Endoscopic Suture Latero-fixation for Treatment of Bilateral Vocal Fold Abductor Paralysis: A Randomized Controlled Trial

Lasheen

Hammouda²,

Mosleh³

et al. 2022

Egyptian Journal of Ear, Nose, Throat and Allied Sciences

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Background: Bilateral vocal fold paralysis (BVFP) is characterized by narrowing of the respiratory glottic chink which could present in the form of an acute airway insufficiency. The aim of this study is to evaluate the efficacy of combined laser posterior cordotomy and endoscopic suture latero-fixation on respiration and phonation. Patients and Methods: This study was a randomized controlled trial, conducted on forty patients, divided into 2 groups: Group (A) included 20 patients underwent combined laser posterior cordotomy and endoscopic suture latero-fixation, while group (B) involved 20 patients subjected to laser posterior cordotomy without latero-fixation for managing BVFP. Results: Group A showed a statistically significant shorter time interval of decannulation from tracheostomy tube after the procedure. (P=0.032). No significant difference between both techniques regarding adequacy of respiratory chink, decannulation rate and voice handicap index scores. Conclusion: Combined laser posterior cordotomy and endoscopic suture latero-fixation is a safe, minimally invasive and effective technique for treatment of BVFP with comparable effect to conventional laser posterior cordotomy regarding respiration and phonation.

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Airway Disorder-Related Dysphagia

Özer,

Saylam

2023

Airway Diseases

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Laser-assisted posterior cordotomy for bilateral vocal fold paralysis: Our experience

Cited by 5 publications

References 0 publications

Endoscopic posterior cordotomy for treatment of dyspnea due to vocal fold immobility

Endoscopic posterior cordotomy for treatment of dyspnea due to vocal fold immobility

Combined Laser Posterior Cordotomy and Endoscopic Suture Latero-fixation for Treatment of Bilateral Vocal Fold Abductor Paralysis: A Randomized Controlled Trial

Airway Disorder-Related Dysphagia

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