Total and Partial Laser Arytenoidectomy for Bilateral Vocal Fold Paralysis.

Taner Yılmaz,Tevfik Sözen,Ozan Muzaffer Altuntaş,Gamze Atay,Oğuz Kuşçu,Serdar Özer,Nilda Süslü

doi:10.1155/2016/3601612

Abstract

Introduction. Treatment for bilateral vocal fold paralysis (BVFP) has evolved from external irreversible procedures to endolaryngeal laser surgery with greater focus on anatomic and functional preservation. Since the introduction of endolaryngeal laser arytenoidectomy, certain modifications have been described, such as partial resection procedures and mucosa sparing techniques as opposed to total arytenoidectomy. Discussion. The primary outcome measure in studies on BVFP treatment using total or partial arytenoidectomy is avoidance of tracheotomy or decannulation and reported success ranges between 90 and 100% in this regard. Phonation is invariably affected and arytenoidectomy worsens both aerodynamic and acoustic vocal properties. Recent reports indicate that partial and total arytenoidectomies have similar outcome in respect to phonation and swallowing. We use CO2 laser assisted partial arytenoidectomy with a posteromedially based mucosal flap for primary cases and reserve total arytenoidectomy for revision. Lateral suturing of preserved mucosa provides tension on the vocal fold leading to better voice and leaves no raw surgical field to unpredictable scarring or granulation. Conclusion. Arytenoidectomy as a permanent static procedure remains a traditional yet sound choice in the treatment of BVFP. Laser dissection provides a precise dissection in a narrow surgical field and the possibility to perform partial arytenoidectomy.

Highlights

Treatment for bilateral vocal fold paralysis (BVFP) has evolved from external irreversible procedures to endolaryngeal laser surgery with greater focus on anatomic and functional preservation
CO2 laser use was expanded to various benign conditions of the larynx, such as recurrent respiratory papillomatosis [4], laryngeal stenosis [5], and the surgical management of bilateral vocal fold paralysis [6] (BVFP)
There is a wide array of studies on endolaryngeal laser arytenoidectomy in the English literature with varying methodology, while the primary outcome measure after laser arytenoidectomy remains respiratory function as reflected by the avoidance of tracheotomy or the possibility of decannulation

Summary

Introduction

From Theodore Maiman’s introduction of the ruby laser [1] to the scientific literature to the advent of carbon dioxide (CO2) laser surgery, the journey of lasers in applied medicine and otolaryngology has encompassed more than six decades. Larynx tissue has ideal properties for CO2 laser use: laryngeal mucosa absorbs the infrared (10,600 nm) wavelength quite well owing to its high water content and high focus provides limited penetration with minimal collateral thermal damage. Considering these advantages, laser laryngosurgery was first utilized in early laryngeal cancer by Strong [3] in 1975 who reported precision for surgical margins and satisfactory postoperative healing after vocal fold resection in 11 cases. The authors aim to detail the current operative technique and discuss the merits of the procedure, potential success rate, and possible complications in the light of current literature

Laser Arytenoidectomy Procedure

Discussion

Findings

Conclusion