The role of endoscopic laterofixation of the vocal cord in the treatment of bilateral abductor paralysis

Abstract

Different techniques were compared in management of 36 patients with bilateral abductor paralysis of the vocal cords. Ten patients were treated by microsurgical arytenoidectomy through a mid-line thyrotomy, with successful decannulation in only three. Fifteen patients were treated by endolaryngeal microsurgical arytenoidectomy, with failure to decannulate four cases.The procedure of endoscopic laterofixation of the vocal cord was used to treat 11 patients. Ten patients had an adequate long-lasting airway with a socially acceptable voice function. One patient had a revision surgery and was successfully decannulated. The technique was found to be a reliable option in the management of bilateral abductor paralysis. It is a modifiable procedure with a feasibility to adjust the position of the vocal cord under endoscopic control. It can be combined with endolaryngeal arytenoidectomy if the gain in the airway size produced by laterofixation is found insufficient.

Simple method of vocal cord lateralization in bilateral abductor cord paralysis in paediatric patients

“…Also, it is possible to modify the results on breathing and voice by tightening or loosening the loop. Unlike laser cordectomy or arytenoidectomy this is a more conservative procedure and avoids the complications of neck dissection associated with extra-laryngeal approach and blunting of anterior commissure seen with midline thyrotomy [10]. Therefore we feel that the suture lateralization is a Simple method of vocal cord lateralization in bilateral abductor cord paralysis in paediatric patients 19 better and reliable option in children with bilateral abductor palsy as it is the most conservative surgical procedure for a condition where the recovery is unpredictable.…”

Endoscopic laterofixation in bilateral vocal cords paralysis in children

“…In literature different techniques were compared in management of patient with bilateral paralysis of the vocal cords for example microsurgical arytenoidectomy through a mid-line thyrotomy, endolaryngeal microsurgical arytenoidectomy, endoscopic laterofixation of vocal cords, laser CO 2 cordotomy or endoscopic posterior costal cartilage graft [7][8][9]11]. In our opinion endoscopic vocal cord laterofixation is effective primary procedure for pediatric vocal cord paralysis.…”

Suture laterofixation of the vocal fold for bilateral vocal fold immobility

“…The need for temporary tracheostomy secondary to airway edema or bleeding appears to be rare, with most cases of laryngeal edema responding to conservative management (i.e., steroid, antibiotics) [19,31,32]. Pulmonary function testing including peak inspiratory flow (PIF) rate, peak expiratory flow rate, forced expiratory volume, forced inspiratory volume and resistance of the airways (RAW) has been used to objectively measure airway improvement, which in most patients is excellent, particularly PIF and RAW [28,29].…”

“…Pulmonary function testing including peak inspiratory flow (PIF) rate, peak expiratory flow rate, forced expiratory volume, forced inspiratory volume and resistance of the airways (RAW) has been used to objectively measure airway improvement, which in most patients is excellent, particularly PIF and RAW [28,29]. Airway improvement appears to persist in most patients for at least 12 months [12,15,19,27] but has been seen to last 5 or more years in some series [23,32,33]. Some degree of mild remedialization 418 Laryngology and bronchoesophagology (1-1.5 mm) is common within the first year, although late remedialization can be seen as well [19,23].…”

“…Lidia et al [25 ] noted that two of 10 pediatric patients (20%) required secondary endoscopic arytenoidectomy to achieve decannulation. Moustafa et al [32] found suture laterofixation successful in 10 of 11 patients, with one requiring arytenoidectomy. Ezzat et al [24 ] reported a 24% reoperation rate in their experience with 21 patients; one ultimately required tracheostomy, three patients required bilateral procedures, and one patient required revision of the laterofixation suture secondary to loosening of the knot.…”