A Novel Surgical Technique for Bilateral Vocal Fold Paralysis: Microlaryngeal Posterior Glottoplasty

Objectives/hypothesis: Bilateral vocal fold paralysis (BVFP) is a clinical condition that may require emergency intervention that is characterized by airway obstruction. The main aspect to be taken under consideration in treatment is to preserve the vocal functions as much as possible while also ensuring an open airway. This study aims to present the preliminary results of a novel surgical method that we refer to as "posterior glottoplasty," which has been performed on BVFP patients to minimize phonation disorder and achieve a better respiratory function.

Methods: Five female patients who developed BVFP-related respiratory distress following total thyroidectomy surgery and underwent "posterior glottoplasty" between 2017 and 2019 were included in our study. Preoperative and postoperative aspiration-swallowing, respiration, and phonation functions were separately evaluated in all patients.

Results: Five subjects were included in the study. All patients were female and between 31 and 67 years of age (mean 47). The mean duration of dyspnea was 58.4 months (range: 6-120). Mean postoperative follow-up time was 11.6 months (range: 6-18). All patients experienced respiratory relief in the postoperative period. Acoustic voice analysis showed minimal to no phonation loss. Minimal aspiration was observed in the early postoperative period which was supposed to be related to the Botulinum effect and it resolved in 2-4 weeks.

Conclusions: The posterior glottoplasty technique aims to increase the posterior (respiratory) glottic space for a better inhalation while keeping the membranous (phonatory) glottic gap to preserve phonation by redirecting the residual or synkinetic muscular vectors. It does not carry major morbidity risks in terms of phonation and aspiration and validates potential spontaneous recovery of the vocal fold paralysis since it preserves the integrity of the cricoarytenoid joints.