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.