CO2 laser endoscopic posterior partial transverse cordotomy for bilateral paralysis of the vocal fold

Objective/Hypothesis: A clinical evaluation of CO2 laser endoscopic posteri or partial transverse cordotomy (EPPTC) in patients with severely compromis ed airway due to bilateral paralysis of the vocal fold. Study Design: An in ception cohort of 25 patients over a 10-year period. Methods: The CO2 laser EPPTC was unilateral in 15 patients and bilateral in 10. Variables were te sted for potential statistical relation to successful rehabilitation of the airway, Results: The use of the CO2 laser never resulted in adverse side e ffects. Complications were not encountered. A one-step, successful restorat ion of the airway was achieved in 68% (17/25) of patients. In univariate an alysis, the CO2 laser EPPTC was statistically more likely to be successful if bilateral EPPTC was performed (P = .018). None of the following variable s-age, sex, cause of bilateral paralysis, prior treatment, laser parameters , and duration of postoperative antibiotherapy and oral steroids-was statis tically related to a successful restoration of the airway. Revision CO2 las er EPPTC, performed in six patients, resulted in an overall 92% (23/25) rat e for a successful restoration of the airway. The overall tracheotomy rate was 8% (2/25). Conclusion: The authors' data confirm the safety, ease of pe rformance, and efficiency of the CO2 laser EPPTC in patients with bilateral vocal fold paralysis. This report also suggests that the completion of bil ateral CO2 laser EPPTC statistically increases the likelihood of restoring the airway in a one-step surgical procedure.