Lateralization of the Vocal Fold: Results of an Exclusive Transoral Approach

Abstract

Objective: Vocal fold paralysis in adduction can result in dyspnea. The authors have previously described an original vocal fold lateralization technique performed exclusively through an endoscopic approach. In this work, we studied long and short-term results of this procedure on dyspnea, phonation, and swallowing.

Study design: Retrospective cohort study through data from medical records and operative notes. Patients with unilateral or bilateral vocal fold paralysis in adduction who underwent transoral lateralization were included.

Methods: In all patients, under laryngosuspension, a supraglottic laryngotomy was performed with CO₂ laser and a lateralization suture was passed through the thyroid cartilage to the vocal process of the vocal fold with the desired tension allowing lateralization of the arytenoid and corresponding vocal fold. We studied evolution of breathing, phonation, and swallowing in all patients who underwent lateralization suture. We tried to correlate symptoms to preoperative and postoperative glottic area, inter-arytenoid distance, and anterior glottic angle.

Results: Eighteen patients were included in the study. Three patients were tracheostomy-dependent and were successfully decannulated. All other cases presented short and long-term significant improvement of their dyspnea index score (P < 0.001) in correlation with glottic area enlargement (P < 0.001). There was no statistical difference between preoperative and postoperative voice and swallowing parameters.

Conclusion: Our transoral lateralization technique allows enlargement of the glottic aperture in case of laryngeal dyspnea secondary to vocal fold paralysis in adduction. This technique optimally preserves laryngeal structures, especially the mucosa. It is reproducible and reliable for all laryngologists experienced in reconstructive transoral laser microsurgery.

Keywords: Arytenoidopexy; R-TLM; Reconstructive transoral laser microsurgery; Tracheostomy; Vocal fold lateralization; Vocal fold paralysis in adduction.