Bilateral vocal fold immobility (BVFI) is a condition that can affect voice with an impact on quality of life (QOL). Surgical trauma from damage to bilateral recurrent laryngeal nerves, such as from previous thyroid, parathyroid, or mediastinal surgery are common causes of bilateral vocal fold immobility. Treatment options are surgical and include posterior cricoid split with graft, posterior cordotomy, medial arytenoidectomy, total arytenoidectomy, tracheostomy, or a combination of these procedures. Posterior cordotomy first described in 1989, involves using a laser to make a transverse cut in the posterior aspect of the more immobile vocal fold. This allows the incised vocal fold to shorten and displace anteriorly, increasing the size of the posterior glottis airway to improve air flow through the glottis. Posterior cordotomy is commonly combined with medial arytenoidectomy, which destroys the vocal process and medial arytenoid cartilage to create more space posteriorly. Complications with posterior cordotomy are rare; however, because it is a destructive procedure, patients may complain about voice changes. In this study subjective and objective voice outcomes were studied following posterior cordotomy with medial arytenoidectomy in patients with BVFI. Retrospective medical record review of 15 patients was performed. Mean follow- up was 2.6 months. Subjective voice outcome was assessed using Voice-Related Quality of Life (VRQOL). For objective voice outcome the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) instrument was used. While postcordotomy patients had a dysphonia that was noticeable to voice professionals, most patients in this study subjectively felt as though their voice improved after surgery.

The results of this study support that posterior cordotomy with medial arytenoidectomy may offer patients improved or unchanged voice quality of life, (VQOL) despite the decrease in overall voice severity perceived by professionals. The findings in this study may help better counsel patients with BVFI considering posterior cordotomy and medial arytenoidectomy. Current preoperative counselling includes discussion of the balance between improved breathing through a larger glottic airway and the subsequent reduced voice quality and volume. While the patient’s voice may lessen in quality and volume to others, there is a good possibility that he or she may feel as though the voice has improved or not changed after surgery. This study does have limitations, it is a small retrospective study with a relatively short follow-up.

Voice outcomes following posterior cordotomy with medial arytenoidectomy in patients with bilateral vocal fold immobility.
Hillel AT, Giraldez L, Samad I, Gross J, Klein AM, Johns MM.
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Shabbir Akhtar

Department of Surgery, The Aga Khan University and Hospital, Karachi, Pakistan.

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