Posterior cordomtomy for bilateral vocal cord paralysis: CO2 laser vs. microsurgery with cold instruments

Abstract

Idea: The restoration of the airways after bilateral vocal cord paralysis is still a challenge for the otolaryngologist. Techniques including endoscopic approaches (Kashima's technique) have been developed for management of adduction bilateral vocal cord paralysis. Method: From 1998 to 2011, 20 patients were endoscopically treated by CO2 Laser (15 patients) and by cold microsurgical instruments (5 patients) in our ENT Department. A better and simpler procedure is cordotomy using the Kashima technique. This involves separating one vocal cord from the vocal process, creating a posterior gap for respiration and maintaining anterior vocal cord contact for phonation.Results: The aetiology of vocal cord paralysis of our patients was the following: posttyroidectomy (8), central nervous system disease (7), idiopathic (5). All treatments were performed in one stage, except for one patient who underwent three month after operation a contralateral cordotomy. Post-operative assessment was performed and consisted of videolaryngoscopy with 70 degree rigid endoscope. The respiratory function and the phonation presented the similar results in both techniques. The healing process was delayed in cases of microsurgery with cold instruments. Speech therapy is used to supplement the operation.Conclusion: Our experience suggests that bilateral vocal cord paralysis can be primarily treated by posterior cordotomy. Moreover, the different therapeutic choices should be adjusted by the surgeon for the patient's gender, age, general conditions, physical and professional activities