Endoscopic total arytenoidectomy for bilateral abductor vocal fold paralysis: a new flap technique and personal experience with 50 cases

OBJECTIVES/HYPOTHESIS: Bilateral vocal fold paralysis is a very serious complication of thyroid surgery, with resulting airway obstruction, aspiration, swallowing disturbance, and voice change. When treated with endoscopic total arytenoidectomy, airway obstruction may be relieved; however, there are concerns that voice may be seriously and irreversibly damaged and aspiration may become a permanent problem.

STUDY DESIGN: Prospective, cohort study.

METHODS: Fifty patients with bilateral vocal fold paralysis underwent endoscopic total arytenoidectomy, medially based mucosal advancement flap, and vocal fold lateralization with endoscopic microsuture. Pre- and postoperative evaluations included Voice Handicap Index (VHI-30), aerodynamic and acoustic analysis, subjective comparison of pre- and postoperative voice by phoniatrician, speech intensity measurement, breathing ability evaluation, and functional outcome swallowing scale.

RESULTS: All VHI-30 results, all aerodynamic analysis results, and all acoustic results (except F0) worsened significantly after surgery (P < .05). Subjective comparison of pre- and postoperative voice by phoniatrician revealed somewhat worse voice (94%). Mean speech intensity decreased from 65 dB to 60 dB postoperatively (P < .05). Postoperative breathing ability was significantly better (90%). The pre- and postoperative functional outcome swallowing scales were not significantly different (P > .05).

CONCLUSIONS: Endoscopic total arytenoidectomy is still a very successful static surgical option for bilateral vocal fold paralysis. It is performed without a tracheotomy, but may be required in some patients postoperatively. Laser is not a requirement for it, and it can easily be done with cold instruments. It attains comfortable airway with acceptable voice. Postoperatively, it does not increase aspiration significantly. It has good long-term results.