Glottic airway gain after ‘suture arytenoid laterofixation’ in bilateral vocal cord paralysis (original) (raw)
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ARYTENOIDCORDECTOMY FOR BILATERAL VOCAL CORD PARALYSIS: PRIMARY AND REVISION PROCEDURE
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 formanagement 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 patientswith 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. Key words: vocal fold paralysis failure, laryngeal stenosis, arytenoidectomy, cordectomy, translaryngeal stenting.
Posterior cordotomy in bilateral vocal cord paralysis
Journal of Otolaryngology-ENT Research, 2022
To determine the rate of resolution of inspiratory dyspnea or decannulation in patients with bilateral cord paralysis in adduction, treated with posterior cordotomy and partial arytenoidectomy. Design Descriptive and retrospective. Methods The electronic medical records of patients who consulted for inspiratory dyspnea or had a tracheostomy due to upper airway obstruction caused by bilateral cord paralysis in adduction between March 2004 and December 2018 were analyzed.
Surgical management of bilateral vocal fold paralysis
Operative Techniques in Otolaryngology-Head and Neck Surgery, 1998
Bilateral vocal fold immobility presents a challenging problem for the otolaryngologist. Although some patients may be managed without intervention, most patients with bilateral true vocal fold immobility require airway management. The goals of such management are usually aimed at producing a safe tracheotomy-free airway, with preservation of deglutition and phonation. Two surgical treatment methods for bilateral true vocal fold immobility are presented: endoscopic submucosal arytenoidectomy with suture lateralization and endoscopic cordotomy with anterolateral arytenoidectomy. The two techniques with their indications, advantages, and complications are illustrated. These modified techniques have resulted in significantly lower rates of the troublesome complication of granuloma formation. Both methods yield a satisfactory glottic airway while maintaining both speech and swallowing.
Surgical Management of Vocal Cord Paralysis: The Need for Careful Patient Selection
African journal of medicine and medical sciences, 2014
BACKGROUND Vocal cord paralysis is one of the challenging laryngeal clinical entities confronting the Laryngologist and indeed, the Phono-surgeon. The ability to maintain an effective balance between voice and airway function to ensure good quality of life requires expertise. This study is therefore designed to highlight our experience on surgical management of vocal cord paralysis. METHOD Clinical notes of all patients that met the inclusion criteria for this study on vocal cord paralysis over a ten-year period were analysed. Data was generated from patients' case files retrieved using standard codes according to the International Classification of Diseases (ICD-10). RESULTS From the 7,941 new ENT cases seen, 26 patients had vocal cord paralysis (VCP) giving a prevalence of 0.3%. The male to female ratio was 1: 4.2 with a mean age of 45.7years ± 6.3. Their ages ranged from 21-80 years. Thyroidectomy was the main causal factor in 46.2% while idiopathic causes was documented in 2...
European Archives of Oto-Rhino-Laryngology, 2007
The problem of ventilation eYciency after total laser arytenoidectomy with posterior cordectomy due to bilateral vocal cord paralysis is discussed. There are a number of views on the usefulness and eYcacy of diVerent surgical procedures aimed at widening the glottis, but the studies concerning the long-term functional results are still lacking. The objective of the study is to evaluate the durability of ventilation results in patients after laser arytenoidectomy with posterior cordectomy based on the comparison between the early postoperative results and those assessed after a period of 5 years. Thirty patients (24 females, 6 males) aged between 30 and 80 (mean 58.5) with bilateral vocal cord paralysis after thyroid surgery, who underwent laser arytenoidectomy with posterior cordectomy, were analyzed. Ventilation tests were performed immediately after the operation and 5 years later with Body-Master Laab (Jaeger). The actual and predicted values of FVC, FEF 25 , FEF 50 , FEF 75 , PEF, MMEF 75/25 , AREA Ex , sR T0T , R T0T were compared and analyzed. Also,
Bilateral vocal fold immobility (BVFI) is a challenging clinical entity for laryngologists. The voice may be nearly normal, but mostly there is a severe inspiratory deficiency. The patients may need surgical interventions primarily for life-threatening dyspnea. While treating the dyspnea, dysphonia appears to be a problem to a certain extent. It is necessary to maintain a balance between providing a serviceable voice and prevention from further surgery for relapsing dyspnea. In the literature, there are various techniques which have been introduced for the surgical management of BVFI. In this report we present a modified approach performed on a BVFI patient, targeting to balance between dyspnea and dysphonia.
Methods of surgical treatment of bilateral vocal fold paralysis
Endokrynologia Polska
Bilateral vocal fold paralysis presents as their complete or partial immobilisation. The median or paramedian position of vocal folds contributes to the narrowing of the airway at the level of the glottis and manifests as inspiratory dyspnoea. For many years iatrogenic injury of recurrent laryngeal nerves during thyroidectomy has been viewed as the most common underlying reason. It is very often a lifethreatening condition requiring not only corticosteroid administration and intubation, which only constitute a short-term symptomatic therapy, but also surgical intervention, including tracheostomy. The most common surgical methods implemented in bilateral vocal fold paralysis include posterior cordectomy, arytenoidectomy, and, more and more commonly, re-innervation. Other techniques used in restoring airway patency include laterofixation, botulinum toxin injection, and laryngeal stimulation, which is still under research. Stem cell and gene therapy are also being researched. Notably, the main purpose of surgical treatment is the provision of airway patency with the preservation of the phonatory and protective functions of the larynx.
International journal of pediatric otorhinolaryngology, 2011
Congenital bilateral vocal fold paralysis (BVP) is a rare but serious condition often requiring a tracheostomy to temporize the airway. In cases of idiopathic BVP, studies suggest waiting twelve months prior to laryngeal surgery because of a high rate of spontaneous recovery. Therefore a less invasive and reversible intervention would be optimal. A prospective study in a piglet model was undertaken to evaluate the efficacy of a novel spring-loaded stenting device designed to maintain laryngeal patency in an in vivo animal model of BVP. Eight Yorkshire piglets had BVP induced by surgical division of the recurrent laryngeal nerves. Stents were endoscopically deployed between the arytenoid vocal processes. Animals were recovered and monitored for stridor, dietary intake, and weight gain. Animals were sacrificed after five days. Airway resistance using a calibrated manometer was measured at four time-points: baseline, BVP induction, stent insertion, and pre-sacrifice. Six of eight anima...