Augmentation-lateralization for Unilateral Vocal Fold Palsy With Airway Obstruction: A New Concept in Laryngology

Noémie Dutrieux; Christol Fabre; Meghana Chanamolu; Paul Francis Castellanos; Ihab Atallah

doi:10.1016/j.jvoice.2023.02.032

Augmentation-lateralization for Unilateral Vocal Fold Palsy With Airway Obstruction: A New Concept in Laryngology

J Voice. 2023 Mar 25:S0892-1997(23)00087-5. doi: 10.1016/j.jvoice.2023.02.032. Online ahead of print.

Authors

Noémie Dutrieux¹, Christol Fabre², Meghana Chanamolu³, Paul Francis Castellanos⁴, Ihab Atallah⁵

Affiliations

¹ Otolaryngology-Head & Neck Surgery Department, Grenoble Alpes University Hospital, Grenoble, France.
² Otolaryngology-Head & Neck Surgery Department, Grenoble Alpes University Hospital, Grenoble, France; School of Medicine, Grenoble Alpes University, Domaine de la Merci, La Tronche, Grenoble, France.
³ Northeast Ohio Medical University, Rootstown, Ohio.
⁴ Mercy Health - St. Rita's Ear, Nose and Throat, Lima, Ohio.
⁵ Otolaryngology-Head & Neck Surgery Department, Grenoble Alpes University Hospital, Grenoble, France; School of Medicine, Grenoble Alpes University, Domaine de la Merci, La Tronche, Grenoble, France. Electronic address: iatallah@chu-grenoble.fr.

PMID: 36973130
DOI: 10.1016/j.jvoice.2023.02.032

Abstract

Objectives: This study presents an efficient, safe, effective, and novel technique of reconstructive transoral laser microsurgery (R-TLM) for the treatment of unilateral vocal fold paralysis (UVFP) with airway obstruction. It is based on the augmentation of the immobile and potentially flaccid and atrophic side while lateralizing the arytenoid and posterior part of the vocal fold, thus improving breathing without sacrificing phonation and commonly improving it.

Study design: Retrospective cohort study through data from medical records and operative notes.

Methods: Patients with UVFP with exertional dyspnea with or without dysphonia were included in this report. The vocal fold is augmented by harvesting the aryepiglottic fold soft tissues and the upper part of the arytenoid and placing them into the paraglottic space as a pedicled microflap, thus augmenting the anterior two thirds of the vocal fold while lateralizing the remaining arytenoid and posterior third of the vocal fold by an internal traction suture to improve airway. Postoperative breathing, phonation and swallowing were assessed.

Results: Twenty two cases are reported in the study. Follow-up evaluations ranged from 6 to 12 months. All cases showed successful and durable improvement of breathing and phonation. None required tracheostomy or gastrostomy pre- or postoperatively.

Conclusions: Augmentation-lateralization is a novel, safe, and effective minimally invasive technique that allows airway improvement with good results on phonation in patients with challenging UVFP with airway obstruction.

Keywords: Unilateral vocal fold paralysis—Vocal fold augmentation—Medialization laryngoplasty—Aryepiglottic fold flap—Reconstructive transoral laser microsurgery—R-TLM.