Laryngofissure approach for bilateral abductor paralysis.

Abstract

BILATERAL vocal cord paralysis with the cords in adduction can be a very serious condition in which the rapid performance of a tracheotomy may be lifesaving. When seen by the laryngologist, the patient has most often progressed to a more chronic stage and breathes either through a marginal glottic airway or a tracheotomy. Thyroid gland surgery and its attendant danger of recurrent laryngeal nerve damage is the most frequent cause of bilateral abductor paralysis. If the recurrent nerves are merely compressed or stretched, cord movement generally returns in a few weeks or months. When the nerves are severed there is little likelihood of spontaneous reinnervation. Central nervous system diseases such as poliomyelitis or meningitis, the effects of toxic materials, head injury, laryngeal or tracheal trauma, and head and neck surgical procedures may all be less frequent causes of permanent vocal cord paralysis. Rheumatoid arthritis or, more rarely, other inflammatory or