Bilateral vocal fold immobility: Clinical findings of ten cases and suggested treatment options |
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| Institution: | 1. Department of Otolaryngology, Toho University Omori Medical Center, 6-11-1, Omorinishi, Otaku 143-8541, Tokyo, Japan;2. Department of Otolaryngology-Head and Neck Surgery, Yokohama City University School of Medicine, Kanagawa, Japan;1. Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, PR China;2. Department of Cardiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150006, PR China;3. Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin 150001, PR China;4. Department of Hematology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, PR China;1. Specialist Trainee in Intensive Care Medicine, Manchester University Hospital NHS Foundation Trust, Southmoor Road, Wythenshawe M23 9LT, UK;2. Consultant in Anaesthesia and Intensive Care Medicine, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Southmoor Road, Wythenshawe M23 9LT, UK;3. Honorary Senior Lecturer, Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, the University of Manchster, Manchester Academic Health Centre, Oxford Road, Manchester M13 9PL, UK;4. Senior Clinical Lecturer in Anaesthesia, Lancaster Medical School, Faculty of Health and Medicine, Lancaster University Lancaster, UK;1. Department of Pathology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido 060-8556, Japan;2. Depertment of Surgical Pathology, Sunagawa City Medical Center, Sunagawa, Hokkaido 073-0196, Japan |
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| Abstract: | ObjectiveTo present the clinical findings of 10 cases of bilateral vocal fold immobility (adducted type) and suggest potential treatment options.MethodsThis retrospective study included 10 patients who underwent tracheostomy for restricted airway due to bilateral vocal fold immobility of the adducted type during the period from 2007 to 2017. All 10 patients underwent unilateral laterofixation surgery with or without additional arytenoidectomy using a CO2 laser. The effect of laterofixation surgery for decannulation was evaluated. Statistical analysis was performed to assess the effects of laterofixation based on the results of preoperative and intraoperative examinations including endoscopic examinations, electromyography, and the intraoperative traction-mobility test.ResultsInitial laterofixation surgery for decannulation was effective in 6 cases. In the 4 cases that exhibited laterofixation failure, additional endoscopic subtotal arytenoidectomy was performed. Statistical analysis of the effects of laterofixation revealed that, in cases with bilateral preserved muscle tone, unilateral simple laterofixation surgery was unable to achieve a significantly effective glottal airway. Additional subtotal arytenoidectomy was also ineffective in a case with bilateral ankylosis.ConclusionBased on the clinical findings in these 10 cases of bilateral vocal fold immobility of the adducted type, treatment options are suggested and a severity classification system of bilateral vocal fold immobility is proposed that focuses mainly on electromyography results for assessment of dynamic restenosis and traction-mobility test results for assessment of static restenosis. Validation of the classification system is needed in a larger cohort of cases of bilateral vocal fold immobility. |
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