KTP-532 laser cordotomy for bilateral abductor paralysis

Various lateralization procedures have been described in the past to treat bilateral vocal cord paralysis. Though endoscopie lateralization gives good results in terms ofdecannulation rates, the postoperative voice quality is often poor. KTP-532 laser assisted posterior cordotomy was done in 3 cases. This preliminary study showd 100% decannulation rate and good post-operative voice quality. The latter was assessed both subjectively and objectively on VAGMI scales.     

CO2 laser endoscopic posterior partial transverse cordotomy for bilateral paralysis of the vocal fold

OBJECTIVE/HYPOTHESIS: A clinical evaluation of CO2 laser endoscopic posterior partial transverse cordotomy (EPPTC) in patients with severely compromised airway due to bilateral paralysis of the vocal fold. STUDY DESIGN: An inception cohort of 25 patients over a 10-year period. METHODS: The CO2 laser EPPTC was unilateral in 15 patients and bilateral in 10. Variables were tested for potential statistical relation to successful rehabilitation of the airway. RESULTS: The use of the CO2 laser never resulted in adverse side effects. Complications were not encountered. A one-step, successful restoration of the airway was achieved in 68% (17/25) of patients. In univariate analysis, the CO2 laser EPPTC was statistically more likely to be successful if bilateral EPPTC was performed (P = .018). None of the following variables--age, sex, cause of bilateral paralysis, prior treatment, laser parameters, and duration of postoperative antibiotherapy and oral steroids--was statistically related to a successful restoration of the airway. Revision CO2 laser EPPTC, performed in six patients, resulted in an overall 92% (23/25) rate for a successful restoration of the airway. The overall tracheotomy rate was 8% (2/25). CONCLUSION: The authors' data confirm the safety, ease of performance, and efficiency of the CO2 laser EPPTC in patients with bilateral vocal fold paralysis. This report also suggests that the completion of bilateral CO2 laser EPPTC statistically increases the likelihood of restoring the airway in a one-step surgical procedure.     

The combined endoscopic CO2 laser posterior cordectomy and total arytenoidectomy for treatment of bilateral vocal cord paralysis

The combined endoscopic CO₂ laser posterior cordectomy and total arytenoidectomy for treatment of bilateral vocal cord paralysis Upper airway obstruction, because of bilateral vocal cord paralysis, presents a serious challenge to the Otolaryngologist. Various surgical techniques have been advocated for the management of patients with vocal cord paralysis. Among these techniques, the individual use of laser CO₂ arytenoidectomy and posterior cordotomy has gained wide acceptance. In this report, we describe our experience in the management of bilateral vocal cord paralysis by combining posterior partial cordotomy as described by Dennis and Kashima, with total arytenoidectomy as described by Ossoff et al. We report the long‐term results in the management of 18 patients treated in our department during the last 8 years.     

Aerodynamic and acoustic parameters in CO2 laser posterior transverse cordotomy for bilateral vocal fold paralysis

The aim of this prospective study was to analyse airway improvement and acoustic and aerodynamic parameters after CO2 laser posterior transverse cordotomy (LPTC) in bilateral vocal fold paralysis (BVFP). Four patients (2 males, 2 females) were recorded pre- and post-operatively at 1, 3, 6, 12 and 24 months. Forced inspiratory volume during the first second (FIV), vital capacity, peakflow, and forced expiratory volume during the first second (FEV) were measured with the Gould II spirometer. Acoustic frequency features (average fundamental frequency, standard deviation, jitter, shimmer and harmonic-to-noise ratio) and speech duration parameters (maximum phonation time, number of words read per minute, and number of words per breath) were measured. Aerodynamic parameters were measured with the Aerophone II. Three tasks were completed. Pneumo-phonatory parameters in "maximum sustained phonation" and in "comfortable phonation", and laryngeal aerodynamic parameters (intraoral air pressure, oral airflow and sound pressure level) were measured non-invasively. Glottal resistance and vocal efficiency were calculated. FIV increased significantly after LPTC (p = 0.01). Postoperatively, frequency features were undetectable by standard commercialized algorithms. Acoustic and aerodynamic parameters improved in the measures obtained at the 6th postoperative month. These results were stable 2 years postoperatively in all cases. We conclude that laryngeal aerodynamic parameters can be used objectively to follow patients longitudinally after LPTC.     

The combined endoscopic CO(2) laser posterior cordectomy and total arytenoidectomy for treatment of bilateral vocal cord paralysis

Upper airway obstruction, because of bilateral vocal cord paralysis, presents a serious challenge to the Otolaryngologist. Various surgical techniques have been advocated for the management of patients with vocal cord paralysis. Among these techniques, the individual use of laser CO(2) arytenoidectomy and posterior cordotomy has gained wide acceptance. In this report, we describe our experience in the management of bilateral vocal cord paralysis by combining posterior partial cordotomy as described by Dennis and Kashima, with total arytenoidectomy as described by Ossoff et al. We report the long-term results in the management of 18 patients treated in our department during the last 8 years.     

Laser arytenoidectomy for bilateral vocal fold paralysis

Laser arytenoidectomy can be performed via an intralaryngeal approach which preserves airway and voice quality without aspiration. Laser arytenoidectomy is minimally invasive surgery, and a useful surgical procedure for bilateral vocal fold paralysis. CO2 laser arytenoidectomy was performed for 12 cases of bilateral vocal fold paralysis. Recommended methods for this surgical procedure are: 1) Submucous laser arytenoidectomy should be done. 2) To widen the posterior glottis, not only the arytenoid cartilage but also the posterior part of the thyroarytenoid muscle should be removed. 3) Membranous portions of the vocal folds should not be vaporized. 4) The wound should be covered with mucosa with fibrin glue.     

Endoscopic laser medial arytenoidectomy for treatment of bilateral vocal fold paralysis

Endoscopic laser medial arytenoidectomy for bilateral vocal fold paralysis has the advantage of preserving the structure and the position of the vocal fold, contrary to a transverse cordotomy or total arytenoidectomy. Our objective was to evaluate the functional results of this procedure. This is a prospective non-randomized study. Twenty patients were included: five patients had a tracheotomy preoperatively and 15 patients had dyspnea on exertion. Acoustic voice measurements, spirometric parameters and the voice handicap index 120 (VHI), were evaluated 1 week before surgery and 3 months after. All the five patients with tracheotomy were successfully decannulated. Acoustic records and VHI were available for eight patients. Jitter and shimmer were worse (p = 0.0078), whereas the VHI was not significantly different after surgery. Spirometric records, available for six patients, were not modified. Endoscopic laser medial arytenoidectomy allowed decannulation and subjective improvement of quality of life in patients with bilateral vocal fold paralysis.     

CO2激光杓状软骨声带突切除与肌腱切断治疗双侧声带外展麻痹

目的：探讨CO2激光杓状软骨声带突切除与肌腱切断治疗双侧声带外展麻痹的应用价值。方法：回顾性分析18例因甲状腺切除术后双侧声带外展麻痹的临床资料,术前预防性气管切开后,行CO2激光杓状软骨声带突切除与肌腱切断术。结果：18例患者术后即可经口鼻呼吸,其中15例于术后8周内拔管;3例于术后4～6周因局部肉芽组织增生再次激光手术后拔管;所有患者随访1．6～2．3年,无呼吸困难及误吸,对发声满意。结论：CO2激光杓状软骨声带突切除与肌腱切断,可有效改善双侧声带外展麻痹造成的呼吸困难,并取得较满意的发声,以及避免误吸。     

CO2激光单侧杓状软骨次全切除术治疗双侧外展性声带麻痹

目的　探讨CO2 激光单侧杓状软骨次全切除术治疗双侧外展性声带麻痹手术的适应证及临床意义。方法　支撑喉镜下对 8例双侧外展性声带麻痹伴呼吸困难的患者实施了CO2 激光单侧杓状软骨次全切除术和手术创面黏膜吻合术。其中 ,继发于双侧甲状腺切除术 5例 ,外伤所致双侧外展性声带麻痹 2例 ,原因不明 1例。术前接受气管造口术 5例 ,气管切开术 1例。术后通过纤维喉镜检查患者新建声门裂的通气情况 ,发音质量主观评估由患者本人和医疗小组共同完成。结果8例患者术后均恢复了满意的呼吸功能 ,发音质量均无明显下降 ,平均气管套管拔除时间为 44 2d。术后随访 5～ 43个月 ,没有出现误吸和再狭窄等并发症。结论　支撑喉镜下CO2 激光单侧杓状软骨次全切除术和创面黏膜吻合术简单易行 ,创面小 ,术后愈合快 ,可避免肉芽组织增生和瘢痕形成所导致的声门区再狭窄 ,患者的呼吸和发音功能均得到了满意的恢复和保留     

CO2 laser treatment of bilateral vocal cord paralysis in adduction

This study presents results obtained from 83 patients with bilateral vocal cord paralysis in adduction treated between 1982 to 2001, with CO(2) laser microlaryngoscopy. In relation to the different types of surgery followed, three distinct treatment groups were included: group 1 (1982-1984) included 5 patients treated with vaporization of the vocal process of the arytenoid and the homolateral posterior third of the true vocal cord. Group 2 (1983-1990) contained 19 patients who were treated with arytenoidectomy and removal of the homolateral posterior half of the true vocal cord and group 3 (1990-2001), including 59 patients who were treated with arytenoidectomy and removal of the homolateral posterior half or two thirds of both the true and false vocal cord. Functional results were assessed by means of spirometry, spectrography and aerophonic examinations performed at 5, 90, 180, and 240 days postoperatively. The results show that removal of the posterior third of the true vocal cord and false vocal cord, combined with arytenoidectomy, is the surgical treatment of choice to resolve respiratory insufficiency in these patients.     

双声带楔形切除术治疗双侧声带外展麻痹

目的：探讨治疗双侧声带外展麻痹的微创外科手术方式——显微支撑喉镜下CO2激光双声带楔形切除术的临床应用价值。方法：使用显微支撑喉镜激光手术系统,治疗4例双侧声带外展麻痹患者。结果：3例经过1次手术,1例经过2次手术,随访5-36个月,患者呼吸困难完全缓解,能耐受日常生活活动;4例均对自己的声音较为满意,能进行日常的生活交流。结论：显微支撑喉镜CO2激光双侧声带楔形切除术,不需气管切开,术后喉功能恢复快,并发症少。既能解决患者通气的要求,又能保证发声的质量,本方法治疗双侧声带外展麻痹有很好的临床推广使用价值。     

CO2 laser endoscopic subtotal arytenoidectomy for bilateral median vocal cord paralysis]

OBJECTIVE: To delineate the surgical procedures and correlated techniques for endoscopic subtotal arytenoidectomy, as well as to discuss their applications and clinical outcomes. METHODS: CO2 Laser endoscopic unilateral arytenoidectomy was performed in eight cases of bilateral median vocal cord paralysis combined with one stage of mucosal micro-anastomosis. All patients suffered from dyspnea in some extent, of which 5 had the history of thyroidectomy and 2 had traumatic causes following esophagectomy and tracheal surgery respectively. One of patient had unknown cause. Six patients had undergone tracheotomy prior to operation or before their referral to our hospital. The airway was evaluated via fibro-optic laryngoscopy, and the voice quality was assessed subjectively by the patients and the surgeon before and after surgery. RESULTS: Following 5-43 months after the surgery, in all cases the function of airway as well as the acceptable voice quality was successfully restored. The tracheotomy done before operation in six patients was decannulated within the mean time of 44.2 days post-operation. CONCLUSION: The endoscopic approach for CO2 laser unilateral arytenoidectomy may lead to better restoration of an adequate airway and satisfying phonation without postoperative aspiration. Mucosal micro-anastomosis can prevent the formation of granulation or scar tissue thus promotes the healing processes. This procedure is simpler than other ordinary surgical methods, and could be a satisfactory alternation of treatment for bilateral median vocal cord paralysis.     

CO2 laser posterior ventriculocordectomy for the treatment of bilateral vocal cord paralysis

We reviewed our clinical experience between 1991 and 1997 concerning use of the CO₂ laser for posterior ventriculocordectomy (PVC) for the treatment of bilateral vocal cord paralysis. Pre- and postoperative functional evaluation was assessed in a prospective setting. In all, 41 patients (33 females and 8 males) underwent an endoscopic CO₂ laser PVC. Pre- and postoperative pulmonary function tests documented a significant statistical improvement in the parameters considered. Sixteen of 21 previously tracheostomized patients were decannulated within 15 months of operation. In no case was a postoperative tracheostomy required. We found no evidence of subclinical aspiration among our cases. Evaluation of vocal parameters by spectrographic analysis was assessed in 20 patients and revealed a postoperative reduction in voice quality. Laser CO₂ PVC seems to be an effective and reliable surgical procedure that allows for rapid decannulation and gives stable results with a low incidence of revision surgery and functional failures. Received: 26 September 1998 / Accepted: 5 April 1999     

CO2 surgical laser in the management of bilateral vocal cord paralysis

Six patients with bilateral vocal cord paralysis who had worn tracheostomy tubes for varying periods of time were treated by CO2 surgical laser. Excision of the vocal process of the arytenoid was done on one side, with ipsilateral cordectomy involving the vocal fold and the vocal ligament. All these patients have been successfully decannulated. The scientific basis of this procedure, and its simplicity and effectiveness without complications, are the main assets of this technique. It is hoped that, by adopting this method of treatment, the management of patients tracheotomized for bilateral vocal cord paralysis will not remain a problem.     

单侧声带横断与声带部分切除术治疗双侧声带外展麻痹

目的探讨用单侧声带横断与声带部分切除术治疗双侧声带外展麻痹的疗效与临床应用价值。方法对9例继发性双侧声带外展麻痹的患者,采用支撑喉镜下单侧声带横断与声带部分切除术进行治疗,通过术后的观察随访,对该术式的临床效果进行分析与评估。结果8例患者气管切开后行单侧声带横断与声带部分切除术,其中7例患者术后2个月安全拔管,1例不能拔管的患者经过再次手术2个月后安全拔管;另1例I度呼吸困难患者经口气管内插管后行声带手术。所有患者行单侧声带横断与声带部分切除术后随访半年以上呼吸困难完全缓解;术后声嘶程度均较前加重,但不影响日常的生活交流。结论单侧声带横断与声带部分切除术治疗双侧声带外展麻痹的方法,不需要昂贵器械,简单实用,临床疗效良好,并发症少,值得在基层医院中推广应用。