Presented at the 2011 Fall Voice Conference at University of California at San Francisco in conjunction with the International Association of Phonosurgery, San Francisco, California, U.S.A., November 2–5, 2011.
Article first published online: 2 AUG 2012
Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 122, Issue 10, pages 2219–2226, October 2012
How to Cite
Yılmaz, T. (2012), Endoscopic total arytenoidectomy for bilateral abductor vocal fold paralysis: A new flap technique and personal experience with 50 cases. The Laryngoscope, 122: 2219–2226. doi: 10.1002/lary.23467
The author has no funding, financial relationships, or conflicts of interest to disclose.
- Issue published online: 20 SEP 2012
- Article first published online: 2 AUG 2012
- Manuscript Accepted: 4 MAY 2012
- Manuscript Revised: 30 MAR 2012
- Manuscript Received: 2 JAN 2012
- Vocal cords;
- vocal cord paralysis;
- arytenoid cartilage;
- laryngeal diseases;
- Level of Evidence:4
Bilateral vocal fold paralysis is a very serious complication of thyroid surgery, with resulting airway obstruction, aspiration, swallowing disturbance, and voice change. When treated with endoscopic total arytenoidectomy, airway obstruction may be relieved; however, there are concerns that voice may be seriously and irreversibly damaged and aspiration may become a permanent problem.
Prospective, cohort study.
Fifty patients with bilateral vocal fold paralysis underwent endoscopic total arytenoidectomy, medially based mucosal advancement flap, and vocal fold lateralization with endoscopic microsuture. Pre- and postoperative evaluations included Voice Handicap Index (VHI-30), aerodynamic and acoustic analysis, subjective comparison of pre- and postoperative voice by phoniatrician, speech intensity measurement, breathing ability evaluation, and functional outcome swallowing scale.
All VHI-30 results, all aerodynamic analysis results, and all acoustic results (except F0) worsened significantly after surgery (P < .05). Subjective comparison of pre- and postoperative voice by phoniatrician revealed somewhat worse voice (94%). Mean speech intensity decreased from 65 dB to 60 dB postoperatively (P < .05). Postoperative breathing ability was significantly better (90%). The pre- and postoperative functional outcome swallowing scales were not significantly different (P > .05).
Endoscopic total arytenoidectomy is still a very successful static surgical option for bilateral vocal fold paralysis. It is performed without a tracheotomy, but may be required in some patients postoperatively. Laser is not a requirement for it, and it can easily be done with cold instruments. It attains comfortable airway with acceptable voice. Postoperatively, it does not increase aspiration significantly. It has good long-term results. Laryngoscope, 2012