MODIFIED POSTERIOR CHORDECTOMY ACCORDING TO DENNIS AND KASHIMA WITH BILATERAL RECURRENT NERVE PARALYSIS

Background: A number of different surgical methods are described in th e literature to enlarge the glottic gap in patients with bilateral rec urrent nerve paralysis with an excessively small glottic gap, The late st method is the posterior chordectomy described by Dennis and Kashima . Patients and Methods: Twenty-three patients with bilateral recurrent nerve paralysis were treated between 1993 and 1997. In the first 5 pa tients, a muscular triangle as described by Dennis and Kashima from th e posterior part of the muscular portion of the vocal fold was resecte d. Later on, the surgical procedure was extended by additional resecti on of muscular tissue from the anterior two-thirds of the vocal fold. Preoperative and postoperative data were carefully assessed in a prosp ective setting. Subjective data such as limitation of physical exertio n and ability to communicate were documented. There was objective docu mentation by spirometry and phoniatric-logopedic assessment of voice q uality parameters. Generally, it takes a number of months until the fi nal permanent state is reached. The minimum follow-up was therefore at least 6 months with a mean of 16 months, Results: The follow-up of th e 23 patients showed that the surgical technique as originally describ ed by Dennis and Kashima does not always improve breathing sufficientl y in the long run. A repeat chordectomy was required in three out of f ive patients with this technique. The modified technique with addition al muscle resection of the anterior two-thirds of the vocal fold resul ted in the desired long-term enlargement of the glottic gap in 16 out of 18 patients. Spirometric controls showed a significant improvement of respiration. However, some voice quality parameters showed a signif icant reduction as expected. Despite this, the overall communication a bility was described as only slightly reduced by the patients themselv es. Conclusions: By the modified posterior laser chordectomy, the glot tic gap is widened on a long term, though less than after an arytenoid ectomy. The compromise between reduction of voice quality and dyspnoea is better than after arytenoidectomy. The preservation of the larynge al sphincter is important in that it prevents the latent aspirations t hat are occasionally observed and achieves a certain adduction of the vocal folds with phonation, The surgical procedure is technically simp le, may be repeated, and never needs a tracheostomy.