Adjustable laterofixation of the vocal fold in bilateral vocal fold paralysis

Abstract

To describe a modification of VF laterofixation in patients with bilateral vocal fold paralysis (VFP), which allows adjusting the sutures tension according to voice and airway patency in the first postoperative day. Prospective case study. Twenty-one patients with recent bilateral VFP were treated by the modified laterofixation technique in Ain-Shams University hospitals between May 2007 and February 2009. Eight male patients and 13 females were included. The median age of the group was 36 years. The standard laterofixation procedure was performed; the Prolene sutures were inserted through the thyroid ala cartilage and looped around the paralyzed VF just anterior to the vocal process. The ultimate tension of the suture was adjusted later in the first postoperative day to gain feedback from the conscious patient about the airway patency and voice quality. Satisfactory immediate result was achieved in 16 patients, with adequate airway, voice, and swallowing. Three other patients required bilateral procedures, one patient needed revision surgery. The procedure failed to achieve a satisfactory airway in one patient who remained dependent on a tracheotomy. The modified laterofixation technique is a reliable first line treatment for recent bilateral VFP.