Current aspects of treatment of patients with bilateral laryngeal paralysis

Abstract

Objectives - to improve the effectiveness of treatment of patients with bilateral laryngeal paralysis by developing a treatment algorithm, justifying the surgical methods and the criteria for the effectiveness evaluation. Material and methods. 52 patients (including 49 women and 3 men) with bilateral larynx paralysis were examined and operated in 2017-2019. The age of the patients ranged from 27 to 71 years. 20 patients underwent the laryngoplasty, including the right-side myoaritenoidchordectomy with laterofixing of the opposite vocal fold with external access. 32 patients received the laryngoplasty with microsurgical technique under the direct support laryngoscopy. Results. The differentiated approach to the surgical treatment of patients with bilateral larynx paralysis allowed to decannulate 97% of patients in early postoperative period with restoration of the respiratory function and preservation of the voice function. In 2 patients it was impossible to form a physiological glottic chink due to a rough scar-dystrophic process in the surgery area. Conclusion. The preliminary use of tracheostomy tube is a factor that impairs the effectiveness of reconstructive surgical interventions in patients with bilateral laryngeal paralysis, if compared to patients with single-step tracheostomy and laryngoplasty. The long course of the bilateral laryngeal paralysis (more than 1 year) leads to persistent and irreversible pathological changes in the arytenoid cartilage and vocal folds. Minimally invasive techniques for the bilateral laryngeal paralysis treatment under the direct support laryngoscopy are the "gold standard" of global laryngology, if the indications for surgery are strictly observed. In all other cases, the patients are subject to a one-step reconstructive surgery with an open approach to the paralyzed voice fold.