Long term result of arytenoidectomy with CO₂ laser for dyspnoea in iatrogenic bilateral vocal fold paralysis patients / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the optimal time of tracheotomy/arytenoidectomy and the improvement of dyspnoea, dysphonia and dysphagia after arytenoidectomy with CO₂ laser in iatrogenic bilateral vocal folds paralysis patients. Method:Thirty patients [29 females, 56 (49-60) years, one male, 49 years] with bilateral vocal cords paralysis resulted from neck surgery were retrospectively analyzed by case archived information and following-up questionnaire. The data included patients' dysponea time, degree and duration from tracheotomy/arytenoidectomy to neck surgery. Twenty sixty patients required unilateral partial/total arytenoidectomy. The results of treatment were evaluated by questionnaire including dyspnoea, dysphonia and dysphagia. Result:All patients whose bilateral vocal paralysis were resulted from thyroid gland surgery. Dysponea occurred immediately after thyroidectomy surgery in 14 cases (46.7%), and 2 years later after thyroidectomy in 13 cases (43.3%), 8 years later in 3 cases (10.0%). There was one (3.3%) patient without tracheotomy. The duration of tracheotomy/arytenoidectomy to neck surgery was significantly correlated with duration of tracheotomy/arytenoidectomy to dyspnoea appearance (r=0.879, P<0.05), not correlated with duration of thyroid surgery to dyspnoea appearance. There is significantly negative correlation between degree of dyspnoea and duration of tracheotomy/arytenoidectomy to neck surgery (r=0.452, P<0.05). Twenty six patients appeared dyspnoea and underwent CO₂ laser arytenoidectomy after thyoidectomy 0.5-23 years. Five patients did unilateral total arytenoidectomy and 21 patients did unilateral partial arytenoidectomy. After 12-96 months following up, dyspnoea improved in 24 patients, no improved in 2 patients. Dysphonia improved and remained in 17 patients, being worse mildly in 8 patients and obviously in one patient. Dysphagia improved and remained in 24 patients, being worse in 2 patients. There was no difference between total and partial arytenoidectomy in dyspnoea, dysphonia and dysphagia. Conclusion:The morbidity of dyspnoea was correlated with time after neck surgery. It was rarely necessary to take tracheotomy immediately in bilateral vocal fords paralysis patients after neck surgery. The severer degree of dyspnoea led to shorter duration between neck surgery and tracheotomy/arytenoidectomy. There was obvious improvement after arytenoidectomy in dyspnoea, no significant change in dysphonia and dysphagia. The effect of total arytenoidectomy on bilateral vocal paralysis was similar to partial arytenoidectomy.

Combined Coblation Total Arytenoidectomy with Posterior Cordectomy for Bilateral Vocal Cord Paralysis / 听力学及言语疾病杂志

Objective To study the out come of coblation arytenoidectomy combined with true and false pos-terior cordectomy for treatment of bilateral vocal cord paralysis (BVFP) .Methods The group included 17 patients (8 incomplete BVFP and 9 complete BVFP) .All the patients had waited more than 6 months before surgery with no spontaneous recovery .The patients underwent arytenoidectomy combined with true and false posterior cordecto-my using coblation under video suspension laryngoscope .Electric fibrolaryngoscope was performed before and after operation to evaluate the size of the glottis .The patients'voices were recorded before and after operation and evalua-ted by 3 laryngologists through GRBAS .Results Preoperational laryngoscope showed that in the incomplete BVFP ,the vocal folds were close to the middle line with limited abduction .In the complete BVFP ,the vocal folds failed in adduction and abduction and the size of the glottis was 2 -3mm .3 of the patients had underwent tracheotomy . Post operational electric fibrolaryngoscope showed proximate triangulate breathing space which was more than 4mm in the posterior glottis .The patients were followed up 6 to 44months .15 of the 17 were allowed for decannulation . One patient among them underwent posterior cordectomy and arytenoidectomy on the contralateral side respectively after the first operation because of dyspnea owing to scar diathesis .Two patients bunged up the canula but did not de-cannulate .Among them one was a 8-year old boy diagnosed as congenital heart disease .One was thyroid cancer with stiff neck due to radiology .The only postoperative complication was the appearance of granulations in the operation region in 2 patients ,which were disappeared spontaneously .Quality of the voice improved in 2 patients ,unchanged in 10 and worsened in 5 .Conclusion This study demonstrates that arytenoidectomy associated with posterior cord-ectomy is a satisfactory surgical treatment of bilateral vocal fold paralysis because it leads to a considerable and stable enlargement of the breathing space and preserved the voice quality .

Descripción de aa percepción del impacto en la alidad de la voz en pacientes mmanejados con cordectomía posterior y aritenoidectomía parcial por estenosis glótica / Description o thhe perceived impact on the quality of voice i patients managged with posterior cordectomy and partial arytenoidectomy because of glottic stenosis / Descrição daperccepção do impacto na qualidade da voz em pacientes tratados com cordectomia posterior e aritenoidectomia parcial por estenose glótica

La estenosis glótica es una afección poco frecuente, secundaria a inmovilidad bilateral de cuerdas vocales, debida principalmente a parálisis de origen neurogénico o a fibrosis cicatricial y en la cual se presenta una incapacidad, generalmente severa, para el paso de aire hacia los pulmones a través de la glotis. Lo anterior hace que con frecuencia se deba recurrir a la realización de una traqueostomía como medida transitoria para asegurar la vía aérea. Para corregir la estenosis y recuperar la permeabilidad glótica, estos pacientes deben ser sometidos a una cirugía cuyo objetivo es separar las cuerdas vocales, para permitir de nuevo el paso de aire a la vía aérea inferior. Sin embargo, el hecho de abrir el espacio glótico separando las cuerdas vocales, va a llevar ineludiblemente a grados variables de alteración en la calidad de la voz, lo cual debe ser siempre informado al paciente antes de su intervención. En el presente estudio se realiza una revisión descriptiva, retrospectiva de los casos tratados por el autor mediante cordectomía posterior y aritenoidectomía parcial entre febrero de 2008 y marzo de 2011. Se reporta en ellos la percepción subjetiva de la afectación en su voz utilizando una versión española del índice de incapacidad vocal adaptada de la versión en inglés del "Voice Handicap Index"-10 (VHI-10). De un total de 32 pacientes sometidos a cirugía por estenosis glótica obstructiva, 28 (17 mujeres y 11 hombres) con edades comprendidas entre los 24 y 79 años cumplieron los criterios de inclusión. A todos los pacientes se les pudo corregir la estenosis y retirar la traqueostomía recuperando la capacidad de respirar por la vía natural. Como resultado se encontró que el índice promedio de incapacidad vocal posterior a la cirugía fue de 10.4 en 18 pacientes, cuya causa era una parálisis bilateral y de 14.2 en 6 pacientes con fibrosis cicatricial como factor desencadenante de la estenosis. En otros 4 pacientes con causas diferentes, el índice promedio fue similar a los anteriores. Estos valores reflejan una percepción de incapacidad vocal leve. En conclusión, la percepción de incapacidad vocal posterior a la cirugía para recuperar la permeabilidad glótica es leve, generándose así un valor agregado al éxito terapéutico, al lograr recuperar la vía aérea natural en los pacientes sin alterar sustancialmente su calidad vocal.

Glottic stenosis is a rare condition secondary to bilateral vocal cord immobility due primarily to paralysis of neurogenic origin or scarring fibrosis with subsequently disability, often severe, for the passage of air into de lungs through the glottis. This means that often we must resort to performing a tracheostomy as a temporary measure to secure the airway. To recover the glottal patency these patients should undergo surgery which aims to separate the vocal cords to again allow the passage of air into the lower airway. However, the fact of opening de glottic space separating the vocal cords inevitably produces varying degrees of alteration in voice quality. In the present study we make a retrospective descriptive review of cases treated by the author with posterior cordectomy and partial arytenoidectomy between February 2008 and March 2011, and we reported their subjective perception of involvement in their voice using a Spanish version of vocal disability index adapted from the English version of the "Voice Handicap Index" -10 (VHI-10). Of a total of 32 patients undergoing surgery for obstructive glottic stenosis, 28 (17 women and 11 men) aged between 24 and 79 years met the inclusion criteria. In all patients it was possible to remove the tracheostomy recovering the ability to breathe by the natural route and the resulting vocal disability index was in average 10.4 in 18 patients with bilateral paralysis, 14.2 in 6 patients with cicatricial fibrosis. In the other 4 remaining patients the average rate was similar to the previous ones. These values reflect a perception of mild vocal inability. In conclusion, in our series the vocal perception of disability following surgery to regain glottal permeability is slight thus creating added value to therapeutic success at recovering the natural airway in these patients.

A estenose glótica é uma afecção pouco frequente, secundária à imobilidade bilateral das cordas vocais, devida principalmente a paralisia de origem neurogênica ou à fibrose cicatricial na qual se apresenta uma incapacidade, geralmente severa, para a passagem do ar aos pulmões através da glote. Isso faz com que com frequência se deva recorrer à realização de uma traqueostomia como medida transitória para garantir a via aérea. Para corrigir a estenose e recuperar a permeabilidade glótica, estes pacientes devem ser submetidos a uma cirurgia cujo objetivo é separar as cordas vocais, para permitir de novo a passagem do ar à aérea inferior. Porém, o fato de abrir o espaço glótico separando as cordas vocais, vai levar inevitavelmente a graus variáveis de alteração na qualidade da voz, isso deve ser sempre informado ao paciente antes de sua intervenção. No presente estudo realiza-se uma revisão descritiva, retrospectiva dos casos tratados pelo autor mediante cordectomia posterior e aritenoidectomia parcial entre fevereiro de 2008 e março de 2011. Reporta-se neles a percepção subjetiva da afetação na sua voz utilizando uma versão espanhola do índice de incapacidade vocal adaptada da versão em inglês do "Voice Handicap Index"-10 (VHI-10). De um total de 32 pacientes submentidos à cirurgia por estenose glótica obstrutiva, 28 (17 mulheres e 11 homens) com idades compreendidas entre 24 e 79 anos cumpriram os critérios de inclusão. A todos os pacientes foi possível corrigir a estenose e retirar a traqueostomia recuperando a capacidade de respirar pela via natural. Como resultado encontrou-se que o índice médio de incapacidade vocal posterior à cirurgia foi de 10.4 em 18 pacientes, cuja causa era uma paralisia bilateral e de 14.2 em 6 pacientes com fibrose cicatricial como fator desencadeante da estenose. Em outros 4 pacientes com causas diferentes, o índice médio foi similar aos anteriores. Estes valores refletem uma percepção de incapacidade vocal leve. Em conclusão, a percepção de incapacidade vocal posterior à cirurgia para recuperar a permeabilidade glótica é leve, gerando-se dessa forma um valor agregado ao sucesso terapêutico, ao conseguir recuperar a via aérea natural nos pacientes sem alterar substancialmente sua qualidade vocal.

LASER Medial Arytenoidectomy in Two Patients of Bilateral Vocal Cord Palsy / 대한이비인후과학회지

Severe airway obstruction occur in bilateral vocal cord paralysis. There exists a variety of treatment methods including external and endoscopic approaches, the endoscopic LASER techniques are more desirable. However, total LASER arytenoidectomy may improve the airway but worsen the voice quality. As an alternative approach, resection medial portion of the arytenoid cartilage may improve the airway with less impairment of voice quality. Our results show that medial arytenoidectomy may be a better treatment method for bilateral vocal cord palsy than the total LASER arytenoidectomy.

Postoperative Evaluation of Laser Arytenoidectomy / 대한이비인후과학회지

BACKGROUND: As methods of improving the airway insufficiency of patients with bilateral vocal cord paralysis, a variety of procedures have been developed such as tracheostomy and endoscopic arytenoidectomy. OBJECTIVES: Our objective was to assess the effectiveness of laser arytenoidectomy in a view to decannulation, aspiration, pulmonary function, and voice analysis in a retrospective study. MATERIALS AND METHODS: Five patients with bilateral vocal cord paralysis had been performed laser arytenoidectomy. Postoperatively, presence of aspiration, decannulation timing and complications were evaluated. The pulmonary function tests were performed preoperatively and postoperatively, while voice analysis was performed only postoperatively. RESULTS: Aspiration was not noticed in all patients after arytenoidectomy, and four patients were decannulated within three months after surgery. Endotracheal tube was ignited in one patient. The results of pulmonary function tests and voice analysis were satisfactory. CONCLUSION: We concluded that laser arytenoidectomy was reliable in the management of the bilateral vocal cord palsy.