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Endoscopic total arytenoidectomy for bilateral abductor vocal fold paralysis: A new flap technique and personal experience with 50 cases

Authors


  • 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.

  • The author has no funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

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.

Study Design:

Prospective, cohort study.

Methods:

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.

Results:

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).

Conclusions:

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

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