Carbon Dioxide Laser Endoscopic Posterior Cordotomy Technique for Bilateral Abductor Vocal Cord Paralysis: A 15-Year Experience

Importance Treatment of bilateral vocal cord paralysis is a considerable challenge for otolaryngologists. Many surgical techniques have been developed for the management of this entity to eliminate the need for tracheotomy. Objective To evaluate the success of the unilateral carbon dioxide laser endoscopic posterior cordotomy technique for bilateral abductor vocal cord paralysis. Design A retrospective study. Setting A university department of otolaryngology–head and neck surgery. Participants Sixty-six patients (58 women and 8 men) diagnosed as having bilateral abductor vocal cord paralysis. Intervention Endoscopic posterior cordotomy with the carbon dioxide laser. Main Outcome Measures Decannulation and postoperative voice quality and exercise tolerance. Results The most common etiologic factor was recurrent laryngeal nerve paralysis after thyroidectomy, observed in 61 patients (92%); an unknown cause was observed in 5 (8%). Unilateral cordotomy sufficed in 58 patients (88%). We performed revision procedures for vocal cord granuloma in 4 patients (6%). Bilateral cordotomy was required for 4 patients (6%) with an insufficient airway. Postoperative tracheotomy was needed for only 4 patients owing to the edema in the operation site. These patients underwent decannulation within a mean period of 7 days. No patient had poor postoperative exercise tolerance. We found no statistically significant difference between the preoperative and postoperative voice quality using the 10-item Turkish version of the Voice Handicap Index. Conclusions and Relevance Carbon dioxide laser endoscopic posterior cordotomy is a safe, minimally invasive, effective technique with a short operation time. A bilateral approach or a revision procedure is rarely required. Bilateral cordotomy should be reserved for patients with insufficient airway passage with unilateral cordotomy.