Coblation Cordotomy for the Management of Bilateral Vocal Fold Immobility.
Bilateral vocal fold immobility (BVFI) has an impact on both the voice and breathing. Many procedures have been developed to manage BVFI including the use of a coblator to perform a unilateral posterior cordotomy. This study evaluated the use of unilateral coblator cordotomy for BVFI.
Retrospective chart review.
Ninety-four patients having undergone coblation cordotomies for BVFI performed by surgeons at two different institutions. Parameters evaluated were etiology of BVFI, prior tracheotomy, the number of revision procedures, postoperative decannulations, breathing outcomes as measured by Dyspnea Index, and voice outcomes as measured by the Voice Handicap Index.
The main causes of immobility were thyroidectomy and prolonged endotracheal intubation. Twenty-one procedures were performed in patients who had a tracheotomy already in place, two required concurrent tracheotomy with cordotomy, and two underwent tracheotomy some time after cordotomy. The mean follow up was 16 months (1-38 months). Of the 25 patients who had a tracheotomy tube placed before or during the course of their care, we were unable to decannulate four of them after initial or revision cordotomy. Twenty of our 94 patients required a secondary revision unilateral cordotomy, usually on the previously un-operated vocal fold. This was more common in bilateral fixation than in paralysis. In 44 patients where Voice Handicap Index data was known both pre- and postoperatively, the median VHI scores improved from 62.2 to 37.4, while the VHI worsened in only four patients. Eight patients had a Dyspnea index performed both pre- and post-operatively and the median score dropped from 18.3 to 12.5.
Coblation cordotomy is a reasonable option for vocal fold lateralization in BVFI. In our study, this method allowed for decannulation in 21 of 25 patients who had a tracheotomy. The initial coblator cordotomy was sufficient for the majority of patients, with 22% (20/94) requiring a revision procedure. Interestingly, our study also showed promising voice outcomes with improvements in VHI in all but four patients.
Benninger MS
，Syamal M
，Gau VL
，Bryson PC
，Hrelec C
... -
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Vocal fold lateralization by percutaneous suture in children: A systematic review.
Percutaneous vocal fold lateralization (PVFL) consists of external fixation with non-absorbable percutaneous suture of the vocal fold in a lateral position, under direct glottic visualization. The objective, through a systematic review, was to identify, select, evaluate, and synthesize the relevant evidence available to define whether PVFL is effective in avoiding the tracheostomy, as well as whether it is effective in allowing decannulation of children who have already been tracheostomized. Secondarily, vocal quality, complications and reversibility of the procedure were evaluated.
A systematic review was carried out based on the protocols described in the QUORUM/PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The search strategy was carried out in the PubMed, Embase, Scopus, Web of Science, SciELO and VHL databases. The terms searched were a combination of indexed keywords using Boolean terms.
Primary studies that documented intervention outcomes in patients with BVFP; Studies including pediatric patients (defined here as <18 years of age); and studies with well documented postoperative follow-up.
Duplicate studies or with the same clinical data; articles that exclusively evaluated other surgical interventions, animal studies, reviews, or post-mortem studies; and studies with only patients with unilateral vocal fold paralysis.
Among the patients under study, 80 cases, underwent the surgical technique under study, 41 of these (51.25 %) are male. The average age of patients undergoing the procedures ranged from 4 days to 10 years of age. Most patients already had preoperative comorbidities, generally cardiothoracic and laryngeal, followed by neurological causes. In 31 % of patients, only a high-flow nasal catheter was required and in 3 patients, transient orotracheal intubation was required. At the mean follow-up of 30 months [SD:24], around 20 of the 80 (25.6 %) patients presented some degree of dysphonia. However, there was no standardization of scales. Approximately 11 % of patients had some postoperative complication, with reintubation due to glottic edema being the most prevalent. There was only 1 death. Preoperatively, 38 % of patients with BVFP were tracheostomized. After the procedure, only 13 % of them still needed to continue with the tracheostomy during the postoperative period. However, 13 % of patients needed to remain with a tracheostomy. Among the tracheostomy patients, only 3 of them achieved return of vocal fold mobility. Among all patients, vocal fold mobility returned in 35 % of patients, with a total of 10 % of patients postoperatively. However, there were studies that did not report mobility due to the short follow-up. During follow-up, 6 patients required revision procedures to relocate lateralization suture or even due to skin abscess. Granuloma occurred in only 1 case. There was just one study reporting suture removal in 3 of its cases.
PVFL is an effective and safe procedure, either due to its high rates of avoiding tracheostomy and allowing decannulation, in addition to the potential for reversibility, or due to its low invasiveness, and can be used to treat PBPV in newborns and infants. However, more controlled studies are needed with longer follow-up of patients, with objective outcomes in the assessment of dysphonia and swallowing, in addition to assessing the incidence of long-term complications. Randomized, multicenter clinical trials are welcome to allow for a larger sample, comparing the efficacy and adverse effects of PVFL in relation to tracheostomy and other existing endoscopic procedures.
Carneiro NS
，Neto JFL
，Salgueiro B
，Padoin RCPK
，Drummond RL
，Harger MC
，Lubianca MN
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Submucosal Thyroarytenoid Myectomy with Arytenoidectomy in Treating Bilateral Vocal Fold Immobility.
Surgery for bilateral vocal fold immobility (BVFI) aims to establish a patent airway while maintaining voice and swallow function, a unique dilemma. Current techniques display unfavorable healing vectors, and exposed endolaryngeal tissue results in substantial airway granulation requiring postoperative care. We present a novel technique to improve glottic airway patency by preserving laryngeal mucosal lining and harnessing lateral retraction of glottic tissue to reduce revisions for granulation tissue and laryngeal scar.
Case-series analysis was performed on eight BVFI patients who underwent submucosal thyroarytenoid myectomy with arytenoidectomy for treatment from 2011 to 2021. Patient medical comorbidities and BVFI etiology were reviewed. Decannulation rates, revision procedures, requirement of emergency services, and pre- and postoperative status were assessed by laryngology and speech-language pathology using the following metrics: VHI, DI, Modified Medical Research Council (MMRC), GRBAS, jitter percentage, shimmer percentage, pitch range, maximum phonation time, and dysphonia severity index, and diet type. Pre- and postoperative distal-chip flexible laryngoscopy with stroboscopy was performed. Outcome measures were assessed using paired Student's t-test of pre- and postoperative categorical variables.
Successful decannulation was achieved in all (four of eight) patients with previous tracheostomy. All patients reported improved respiratory symptoms without tracheotomy. There was no difference in long-term voice outcomes. All patients tolerated a mechanical soft or regular diet, without new or worsened dysphagia.
Submucosal thyroarytenoid myomectomy with arytenoidectomy represents an effective BVFI treatment, through utilizing natural vectors of scarring, preservation of endolaryngeal mucosa, and preservation of the superficial lamina propria and the vocal ligament.
4 Laryngoscope, 135:1460-1464, 2025.
Damazo B
，Nanda N
，Dailey S
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ResearchGate
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