What are the airway, voice and swallowing outcomes of a mucosal-sparing surgical approach to improving the glottic airway in bilateral vocal fold immobility?
Reviewed by Gemma Clunie

Bilateral vocal fold immobility (BVFI) causes significant breathing problems as well as voice and swallowing difficulties. Surgical interventions aim to enlarge the glottic outlet by altering or removing glottic structures which improve breathing but often lead to worsening dysphonia and dysphagia. In this study, the authors present a case series demonstrating a new surgical technique, using submucosal resection of the thyroarytenoid muscle and medial arytenoid complex. The technique can be endoscopic or open and aims to maximise airway patency whilst preserving the laryngeal mucosa, thus minimising impact on voice and swallowing. The authors operated on eight patients between 2011 and 2023. They assessed airway, voice and swallowing outcomes prior to surgery and then every three months for an average of two years post surgery. Four patients had a tracheostomy prior to surgery, with three being successfully decannulated following the procedure. Pre-surgery Vocal Handicap Index (VHI-10) scores were 25.9 ± 15.8 compared to 27.5 ± 15.6 two years post operatively, demonstrating no significant difference (p=0.68). Maximum phonation times (MPT) were similarly unaffected. The authors do acknowledge that immediately after the operation there was a deterioration in voice quality for some and recommend that counselling about the risk to voice, and voice therapy are available to patients. Swallowing was also stable pre and post surgery, as assessed by the Eating Assessment Tool (EAT-10) 5.5 ± 4.9 compared to 6.1 ± 2.9 (p=0.61). The authors recommend that this surgical technique shows promise for maximising functional outcomes in BVFI patients but acknowledge that a larger prospective study will be required to confirm its benefits.

Submucosal Thyroarytenoid Myectomy with Arytenoidectomy in Treating Bilateral Vocal Fold Immobility.
Damazo B, Nanda N, Dailey S.
LARYNGOSCOPE
2025;135(4):1460–4.