Outcomes of CO2 laser-assisted posterior cordectomy in bilateral vocal cord paralysis in 132 cases

Joanna Jackowska,Krzysztof Piersiala,Hanna Czerniejewska-Wolska,Elisabeth V Sjogren,Anna Bartochowska,Malgorzata Wierzbicka

doi:10.1007/s10103-018-2478-9

Joanna Jackowska, Krzysztof Piersiala + Show 4 more

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https://doi.org/10.1007/s10103-018-2478-9

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Abstract

The purpose of the study was to assess the role of laser-assisted posterior cordectomy in the management of patients with bilateral vocal cord paralysis. We aimed an analysis of 132 consecutive patients treated by CO2 laser posterior cordectomy, aged 38–91, 31% tracheotomized on admission. Cordectomy was performed under microlaryngoscopy using CO2 laser (Lumenis AcuPulse 40 CO2 laser, wavelength 10.6 μm, Lumenis Ltd., Yokneam, Israel). We looked at the number of laser glottic procedures necessary to achieve decannulation in tracheotomized patients and to achieve respiratory comfort in non-tracheotomized subjects and we evaluated the two groups for differences in patient characteristics. In tracheotomized patients, we also assessed factors affecting the success of decannulation and we evaluated the impact of tracheotomy on patients’ lives. Decannulation was performed in 63% of tracheotomized patients. In terms of the number of procedures, 54% (14), 19% (5), and 27% (7) tracheotomized vs. 74% (61), 24% (20), and 2% (2) non-tracheotomized subjects underwent one, two, or three procedures, respectively. In the group of tracheotomized patients who were successfully decannulated, the number of multiple laser-assisted procedures was significantly higher than in the group of non-tracheotomized subjects with respiratory comfort after treatment (p = 0.04). Advanced age (> 66 years), comorbidities (diabetes, gastroesophageal reflux disease (GERD)), multiple thyroid surgeries, and tracheotomy below the cricoid cartilage were found to decrease the likelihood of successful decannulation. Posterior cordectomy is a simple method allowing for airway improvement and decannulation in patients with bilateral vocal cord paralysis. It is less effective in tracheotomized subjects with diabetes or GERD, older than 66 years old, after two or more thyroidectomies.

Highlights

Joanna Jackowska, Elisabeth V Sjogren, Anna Bartochowska, Hanna Czerniejewska-Wolska, Krzysztof Piersiala and Malgorzata Wierzbicka contributed to this work.According to multicenter analyses, there are multiple reasons for bilateral vocal cord immobilization, but the prevailing reason, accounting for 26–59% of all reported cases, is bilateral vocal cord paralysis is iatrogenic due to surgery within the neck as well as cardio, thoraco, and neurosurgical procedures [1,2,3,4,5,6,7]
This study was conducted in a tertiary referral center, in 132 consecutive patients with bilateral vocal cord paralysis with a significant airway compromise admitted for CO2 laser posterior cordectomy as described by Dennis and Kashima [19] between 2010 and 2014 (Fig. 1)
To assess the role of laser-assisted posterior cordectomy in this patient cohort, we registered in how many patients the treatment was successful

Summary

Introduction

There are multiple reasons for bilateral vocal cord immobilization, but the prevailing reason, accounting for 26–59% of all reported cases, is bilateral vocal cord paralysis is iatrogenic due to surgery within the neck (thyroid, parathyroid glands, thymus, esophagus, carotid body paragangliomas) as well as cardio-, thoraco-, and neurosurgical procedures [1,2,3,4,5,6,7]. Thyroid surgery is the single most common cause of persistent iatrogenic bilateral cord paralysis and accounts for almost a quarter of all cases [5, 10,11,12,13,14,15]. The problem occurs in 1% of thyroidectomies; it is likely to be more frequent in thyroid cancer surgeries, retrosternal goiter, major intraoperative bleeding, and multiple thyroid surgeries (20–30%) [9, 14, 16, 17].

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