Posterior cordotomy in bilateral vocal cord paralysis

Abstract

Introduction: Bilateral vocal cords paralysis in adduction when it is irreversible requires treatment due to the inspiratory dyspnea that produces. Different surgical techniques can be used to increase the glottic space. Posterior cordotomy with partial arytenoidectomy improves dyspnea and is one of the most used surgeries. Objectives: To determine the resolution rate of inspiratory dyspnea or decannulation, in patients with bilateral vocal cord paralysis in adduction treated with posterior cordotomy and partial arytenoidectomy Methods: A retrospective and descriptive study was carried out by analyzing the electronic medical records of all patients who had bilateral vocal cords paralysis in adduction and were treated with posterior cordotomy and partial arytenoidectomy between March 2004 and December 2018. The result of the posterior cordotomy with partial arytenoidectomy was determined according to the decannulation rate of the patients who had tracheostomy, according to dyspnea resolution after the cordotomy and by the increase of the postoperative glottic space evidenced by endoscopy. Results: Nineteen patients were treated by bilateral vocal cord paralysis in adduction. The most frequent cause was a total thyroidectomy (9/19). Eight had a tracheostomy prior to posterior cordotomy. Seven of eight patients who had tracheostomy were able to decannulate, the rest had insufficient glottic space and did not return to control. All patients without tracheostomy (11/19) improved their inspiratory dyspnea and had no limitation for their daily life activities. Conclusions: The resolution of inspiratory dyspnea in patients with bilateral vocal cords paralysis in adduction without tracheostomy, treated with posterior cordotomy and partial arytenoidectomy was 100% (11/11). In tracheotomized patients the decannulation rate was 87,50% (7/8).