Dilatation of the glottis in bilateral vocal cord paralysis. Review of various surgical procedures and a report of personal experience using a functional lateral fixation surgical technic

: For the treatment of bilateral vocal cord paralysis, the author's technique consists of preservation of the posterior crico-arytenoid ligament as a hinge as well as turning and tilting of the arytenoid cartilage laterally. It is held in this position with three permanent retention sutures, two of them armed with heavy knots. These knots will reinforce the lateral rotation of the arytenoid cartilage. These sutures run in the submucosa horizontally along the anterior surface of the arytenoid cartilage and are fixed through burr holes on the posterior margin of the thyroid cartilage. This method developed from the original "King Procedure" leaves the laryngeal mucosa maximally undisturbed so that in 80% of the cases preliminary tracheotomy became unnecessary. During a period of 27 years, 110 patients were operated; 27 of them had a previously created tracheostoma. Out of the remaining 83, 16 had tracheotomy directly before surgery. Of the remaining 67 patients, four required postoperative tracheotomy for a few days only, while 63 did not require this additional treatment. The average hospital stay was 11 days. In the majority of cases the operation could be performed under local anaesthesia which helped to establish proper voice function.