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[Endolaryngeal surgical procedures in glottis expansion in bilateral recurrent nerve paralysis].
Laryngorhinootologie. 1996 Apr; 75(4):215-22.L

Abstract

OBJECTIVE

Subtotal cordectomy and posterior cordectomy have repeatedly been recommended as surgical interventions restoring the airway, for the treatment of bilateral vocal cord paralysis. The objective of this study was to assess the effectiveness of transoral laser cordectomy and posterior cordectomy as compared to laser arytenoidectomy and to compare the respiratory and phonatory results of these minimally invasive procedures.

MATERIAL AND METHODS

Forty patients with bilateral vocal cord paralysis were included in a prospective study and operated upon to improve their laryngeal airways. Twenty-two patients had cordectomy, 13 had arytenoidectomy, and 5 had posterior cordectomy. Lung function tests and voice analysis were obtained preoperatively and postoperatively. Subclinical aspiration was determined by endoscopic evaluation of the larynx during deglutition. The results were compared to determine the relative effectiveness of the three surgical methods.

RESULTS

Flow volume spirograms documented equally improved flow rates in both groups. Final voice evaluation revealed maximum phonation time. Peak sound pressure levels and frequency range were reduced in all 28 patients, but phonatory results varied considerably in each group. Subclinical aspiration was noticed in 5 out of 10 patients after arytenoidectomy, but in none of 18 patients after cordectomy. Four previously tracheotomised patients were decannulated within 2 weeks after surgery, while the other 24 patients had no perioperative tracheotomies.

CONCLUSION

Transoral laser cordectomy and arytenoidectomy are equally effective and reliable in the management of the restricted airway. Cordectomy and posterior cordectomy offer the advantage of uncompromised deglutition after surgery. Although no clinically relevant aspiration occurred in any of the patients, cordectomy should be considered as the method of choice in patients for whom subclinical aspiration could be potentially harmful due to coexisting pulmonary or cardiac disease. Phonatory outcome is not predictable with both surgical procedures. Subtotal cordectomy and posterior cordectomy are easier and faster to perform, and subclinical aspiration is not encountered with these procedures.

Authors+Show Affiliations

Universität-Hals-Nasen-Ohrenklinik Köln.No affiliation info available

Pub Type(s)

Comparative Study
English Abstract
Journal Article

Language

ger

PubMed ID

8688127

Citation

Eckel, H E., and M Vössing. "[Endolaryngeal Surgical Procedures in Glottis Expansion in Bilateral Recurrent Nerve Paralysis]." Laryngo- Rhino- Otologie, vol. 75, no. 4, 1996, pp. 215-22.
Eckel HE, Vössing M. [Endolaryngeal surgical procedures in glottis expansion in bilateral recurrent nerve paralysis]. Laryngorhinootologie. 1996;75(4):215-22.
Eckel, H. E., & Vössing, M. (1996). [Endolaryngeal surgical procedures in glottis expansion in bilateral recurrent nerve paralysis]. Laryngo- Rhino- Otologie, 75(4), 215-22.
Eckel HE, Vössing M. [Endolaryngeal Surgical Procedures in Glottis Expansion in Bilateral Recurrent Nerve Paralysis]. Laryngorhinootologie. 1996;75(4):215-22. PubMed PMID: 8688127.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Endolaryngeal surgical procedures in glottis expansion in bilateral recurrent nerve paralysis]. AU - Eckel,H E, AU - Vössing,M, PY - 1996/4/1/pubmed PY - 1996/4/1/medline PY - 1996/4/1/entrez SP - 215 EP - 22 JF - Laryngo- rhino- otologie JO - Laryngorhinootologie VL - 75 IS - 4 N2 - OBJECTIVE: Subtotal cordectomy and posterior cordectomy have repeatedly been recommended as surgical interventions restoring the airway, for the treatment of bilateral vocal cord paralysis. The objective of this study was to assess the effectiveness of transoral laser cordectomy and posterior cordectomy as compared to laser arytenoidectomy and to compare the respiratory and phonatory results of these minimally invasive procedures. MATERIAL AND METHODS: Forty patients with bilateral vocal cord paralysis were included in a prospective study and operated upon to improve their laryngeal airways. Twenty-two patients had cordectomy, 13 had arytenoidectomy, and 5 had posterior cordectomy. Lung function tests and voice analysis were obtained preoperatively and postoperatively. Subclinical aspiration was determined by endoscopic evaluation of the larynx during deglutition. The results were compared to determine the relative effectiveness of the three surgical methods. RESULTS: Flow volume spirograms documented equally improved flow rates in both groups. Final voice evaluation revealed maximum phonation time. Peak sound pressure levels and frequency range were reduced in all 28 patients, but phonatory results varied considerably in each group. Subclinical aspiration was noticed in 5 out of 10 patients after arytenoidectomy, but in none of 18 patients after cordectomy. Four previously tracheotomised patients were decannulated within 2 weeks after surgery, while the other 24 patients had no perioperative tracheotomies. CONCLUSION: Transoral laser cordectomy and arytenoidectomy are equally effective and reliable in the management of the restricted airway. Cordectomy and posterior cordectomy offer the advantage of uncompromised deglutition after surgery. Although no clinically relevant aspiration occurred in any of the patients, cordectomy should be considered as the method of choice in patients for whom subclinical aspiration could be potentially harmful due to coexisting pulmonary or cardiac disease. Phonatory outcome is not predictable with both surgical procedures. Subtotal cordectomy and posterior cordectomy are easier and faster to perform, and subclinical aspiration is not encountered with these procedures. SN - 0935-8943 UR - https://www.unboundmedicine.com/medline/citation/8688127/[Endolaryngeal_surgical_procedures_in_glottis_expansion_in_bilateral_recurrent_nerve_paralysis]_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1055/s-2007-997565 DB - PRIME DP - Unbound Medicine ER -