gms | German Medical Science

Objectives: Standard endoscopic solutions for bilateral vocal cord palsy (VCP) give generally a poor compromise between breathing and voicing. These interventions are based mainly on the different resection of the glottic structures providing a static enlargement of the airway. Recent studies revealed a spontaneous adduction recovery even in most cases of permanent VCP, thus theoretically a reliable glottis enlarging procedure which preserves the participating anatomical structures in this process may provide a more favorable compromise in terms of voice and breathing.

Methods: Endoscopic arytenoid lateropexy (EAL) is an effective technique based on the arytenoid abduction with sutures. Preservation of laryngeal structures ensures the above mentioned criteria. Respiratory and phoniatric results (acoustics, perception, videostroboscopy and self-evaluation) of consecutive 20 patients with bilateral permanent VCP were assessed with one year follow up.

Results: 11 patients had incomplete dominantly adduction contralateral vocal cord recovery, with slightly impaired voice quality. 4 patients had socially acceptable voice, but false vocal cord phonation. Five patients had complete palsy with poor phoniatric outcome. All of the patients had remarkably increased stable spirometric result allowing an improved quality of life.

Conclusion: Dynamic solution of bilateral VCP is a hot topic of laryngology, however, rutin clinical efficacy of laryngeal reinnervation and laryngeal pacing has not been proven unambiguously. In 75% of the patients of this series the simple EAL allowed an immediately and remarkably improved breathing coupled good or acceptable voice due to the regenerated vocal cord adduction. This may mean a simpler dynamic solution for most bilateral permanent BVCP.