Abstract
PurposeEndoscopic arytenoid abduction lateropexy (EAAL) is a reliable surgical solution for the minimally invasive treatment of bilateral vocal fold palsy (BVFP), providing a stable airway by the lateralization of the arytenoid cartilages with a simple suture. The nondestructive manner of the intervention theoretically leads to higher regeneration potential, thus better voice quality. The study aimed to investigate the respiratory and phonatory outcomes of this treatment concept.Methods61 BVFP patients with significant dyspnea associated with thyroid/parathyroid surgery were treated by unilateral EAAL. Jitter, Shimmer, Harmonics to Noise Ratio, Maximum Phonation Time, Fundamental frequency, Voice Handicap Index, Dysphonia Severity Index, Friedrich’s Dysphonia Index, Global-Roughness-Breathiness scale, Quality of Life, and Peak Inspiratory Flow were evaluated 18 months after EAAL.ResultsAll patients had a stable and adequate airway during the follow-up. Ten patients (16.4%) experienced complete bilateral motion recovery with objective acoustic parameters in the physiological ranges. Most functional results of the 13 patients (21.3%) with unilateral recovery also reached the normal values. Fifteen patients (24.6%) had unilateral adduction recovery only, with slightly impaired voice quality. Eleven patients (18.0%) had false vocal fold phonation with socially acceptable voice. In 12 patients (19.7%) no significant motion recovery was detected on the glottic level.ConclusionEAAL does not interfere with the potential regeneration process and meets the most important phoniatric requirements while guaranteeing the reversibility of the procedure—therefore serving patients with transient palsy. Further, a socially acceptable voice quality and an adequate airway are ensured even in cases of permanent bilateral vocal fold paralysis.
Highlights
Despite the continuous development of surgical techniques, bilateral recurrent laryngeal nerve (RLN) injury mainly occurs as a major complication of thyroid/parathyroid surgery [1]
We sequentially evaluated 65 patients who were managed for bilateral vocal fold palsy (BVFP)
The comparison of the functional outcomes of different surgical techniques addressing BVFP raises a complex question, because the functional results depend on the surgical method as well as a patient’s age, sex, mental and physical health, and the potential regeneration of the recurrent laryngeal nerve
Summary
Despite the continuous development of surgical techniques, bilateral recurrent laryngeal nerve (RLN) injury mainly occurs as a major complication of thyroid/parathyroid surgery [1]. Continuous improvement of anesthesia and the development of diagnostic and surgical techniques over recent decades have enabled physicians to avoid implementing this highly unpleasant intervention. Most surgical techniques employ resection of laryngeal structures on some level (e.g., arytenoidectomy and/or cordotomy) having a significant negative impact on voice quality [2, 6,7,8].
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