CORDECTOMY VERSUS ARYTENOIDECTOMY IN THE MANAGEMENT OF BILATERAL VOCAL CORD PARALYSIS

Our objective was to assess the effectiveness of transoral laser corde ctomy and laser arytenoidectomy and to compare the results with a view to respiratory and phonatory function and deglutition. Twenty-eight p atients with bilateral vocal cord paralysis were included in a prospec tive study. Eighteen patients had cordectomy, and 10, arytenoidectomy. Lung function tests and voice analysis were performed preoperatively and postoperatively. Subclinical aspiration was determined by endoscop ic evaluation of the larynx during deglutition. The results were compa red to determine the relative effectiveness of both surgical methods. Flow volume spirograms documented equally improved flow rates in both groups. The final voice evaluation revealed that maximum phonation tim e, peak sound pressure levels, and frequency range were reduced in all 28 patients, but the phonatory results varied considerably in each gr oup. Subclinical aspiration was noticed in 5 of 10 patients after aryt enoidectomy, but in none of 18 patients after cordectomy. Four of 6 pr eviously tracheostomized patients were decannulated within 2 weeks aft er surgery, while the other 22 patients had no perioperative tracheost omies. We conclude that transoral laser cordectomy and arytenoidectomy are equally effective and reliable in the management of the restricte d airway. Phonatory outcome is not predictable with either surgical pr ocedure. Cordectomy is easier and faster to perform, and subclinical a spiration is not encountered with this procedure.