Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-28T17:03:53.156Z Has data issue: false hasContentIssue false
  • English
  • Français

Unilateral transverse cordotomy for bilateral abductor vocal fold immobility

Published online by Cambridge University Press:  18 July 2012

J M Bernstein ,
S M Jones  and
P H Jones
J M Bernstein*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
S M Jones
Affiliation:
Department of Speech, Voice and Swallowing, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
P H Jones
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
*
Address for correspondence: Mr Jonathan M Bernstein, Specialist Registrar, Otolaryngology – Head and Neck Surgery, c/o Department of Otolaryngology – Head and Neck Surgery, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK Fax: +44 (0)161 446 8111 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

We present a case series with airway compromise due to bilateral abductor vocal fold paralysis or fixation, treated with unilateral transverse cordotomy.

Methods:

Of eight consecutive patients with dyspnoea due to bilateral paramedian vocal fold immobility, seven underwent unilateral transverse cordotomy between August 2006 and April 2010 at University Hospital of South Manchester, UK. Airway and voice outcomes were compared before and after surgery.

Results:

All seven treated cases derived subjective airway function improvement; there was no aspiration. The eighth case had inadequate access. None of the seven treated patients required contralateral cordotomy or permanent tracheostomy. One treated case required a temporary tracheostomy; unilateral transverse cordotomy facilitated eventual decannulation. Two patients died of cancer at five and six weeks, variously. At a mean follow up of 22 months, four cases showed unchanged or slightly worse Voice Symptom Scale and Grade-Roughness-Breathiness-Asthenia-Strain scale scores.

Conclusion:

In patients with bilateral abductor vocal fold immobility, unilateral transverse cordotomy results in improved dyspnoea with either no voice change or only slight worsening. This is a more conservative procedure than bilateral transverse cordotomy, with the potential for better preservation of voice and breath support.

Keywords

Vocal Cord ParalysisCordotomyLarynxSurgical Procedures, Operative
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 9 , September 2012 , pp. 913 - 917
Copyright
Copyright © JLO (1984) Limited 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Presented as a poster at Laryngology 2011, 20–22 June 2011, London, UK, and orally at the North of England Otolaryngology Society, 24 September 2011, Brighouse, UK

References

1Kashima, HK. Bilateral vocal fold motion impairment: pathophysiology and management by transverse cordotomy. Ann Otol Rhinol Laryngol 1991;100:717–21CrossRefGoogle ScholarPubMed
2Bajaj, Y, Sethi, N, Shayah, A, Harris, AT, Henshaw, P, Coatesworth, AP et al. Vocal fold paralysis: role of bilateral transverse cordotomy. J Laryngol Otol 2009;123:1348–51CrossRefGoogle ScholarPubMed
3Fletcher, CM. Standardised questionnaire on respiratory symptoms: a statement prepared and approved by the MRC Committee on the Aetiology of Chronic Bronchitis (MRC breathlessness score). BMJ 1960;2:1655Google Scholar
4Webb, AL, Carding, PN, Deary, IJ, MacKenzie, K, Steen, N, Wilson, JA. The reliability of three perceptual evaluation scales for dysphonia. Eur Arch Otorhinolaryngol 2004;261:429–34CrossRefGoogle ScholarPubMed
5Wilson, JA, Webb, A, Carding, PN, Steen, IN, MacKenzie, K, Deary, IJ. The Voice Symptom Scale (VoiSS) and the Vocal Handicap Index (VHI): a comparison of structure and content. Clin Otolaryngol Allied Sci 2004;29:169–74CrossRefGoogle ScholarPubMed
6Jackson, C. Ventriculocordectomy: a new operation for the cure of goitrous paralytic laryngeal stenois. Arch Surg 1922;4:257–74CrossRefGoogle Scholar
7King, B. A new and function-restoring operation for bilateral abductor cord paralysis. JAMA 1939;112:814–23CrossRefGoogle Scholar
8Kelly, J. Surgical treatment of bilateral paralysis of the abductor muscles. Arch Otolaryngol 1941;33:293–304CrossRefGoogle Scholar
9Woodman, D. A modification of the extralaryngeal approach to arytenoidectomy for bilateral abductor paralysis. Arch Otolaryngol 1946;43:63–5CrossRefGoogle ScholarPubMed
10Thornell, WC. Intralaryngeal approach for arytenoidectomy in bilateral abductor paralysis of the vocal cords; a preliminary report. Arch Otolaryngol 1948;47:505–8CrossRefGoogle ScholarPubMed
11Citelli, C. External cordectomy. About a new treatment for laryngeal restriction resulting from permanent median position of the vocal cords [in German]. Arch Laryngol Rhinol 1908;20:73–97Google Scholar
12Burian, K, Hofler, H. On microsurgical treatment of vocal cord carcinomas with CO2-laser [in German]. Laryngol Rhinol Otol (Stuttg) 1979;58:551–6Google ScholarPubMed
13Steiner, W, Ambrosch, P. Endoscopic Laser Surgery of the Upper Aerodigestive Tract, with Special Emphasis on Cancer Surgery. Stuttgart: Thieme, 2000Google Scholar
14Dennis, DP, Kashima, H. Carbon dioxide laser posterior cordectomy for treatment of bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol 1989;98:930–4CrossRefGoogle ScholarPubMed
15Eckel, HE, Thumfart, M, Wassermann, K, Vossing, M, Thumfart, WF. Cordectomy versus arytenoidectomy in the management of bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol 1994;103:852–7CrossRefGoogle ScholarPubMed
16Remacle, M, Lawson, G, Mayne, A, Jamart, J. Subtotal carbon dioxide laser arytenoidectomy by endoscopic approach for treatment of bilateral cord immobility in adduction. Ann Otol Rhinol Laryngol 1996;105:438–45CrossRefGoogle ScholarPubMed
17Hartnick, CJ, Brigger, MT, Willging, JP, Cotton, RT, Myer, CM 3rd. Surgery for pediatric vocal cord paralysis: a retrospective review. Ann Otol Rhinol Laryngol 2003;112:1–6CrossRefGoogle ScholarPubMed
18Wang, S, Zhou, S, Xu, Y. Cordotomy for bilateral cord abductal paralysis. Chin Med J (Engl) 2001;114:542–3Google ScholarPubMed
19Bosley, B, Rosen, CA, Simpson, CB, McMullin, BT, Gartner-Schmidt, JL. Medial arytenoidectomy versus transverse cordotomy as a treatment for bilateral vocal fold paralysis. Ann Otol Rhinol Laryngol 2005;114:922–6CrossRefGoogle ScholarPubMed
20Lagier, A, Nicollas, R, Sanjuan, M, Benoit, L, Triglia, JM. Laser cordotomy for the treatment of bilateral vocal cord paralysis in infants. Int J Pediatr Otorhinolaryngol 2009;73:9–13CrossRefGoogle ScholarPubMed
21Gokcan, MK, Kurtulus, DF, Ustuner, E, Ozyurek, E, Kesici, GG, Erdem, SC et al. A computational study on the characteristics of airflow in bilateral abductor vocal fold immobility. Laryngoscope 2010;120:1808–18CrossRefGoogle Scholar