CO2 laser subtotal arytenoidectomy and posterior true and false cordotomy in the treatment of post-thyroidectomy bilateral laryngeal fixation in adduction

A total of 39 patients with bilateral post-thyroidectomy vocal cord paralys is in adduction underwent CO2 laser subtotal arytenoidectomies with removal of the posterior third of the false and true vocal cords. Total airway res istance (R-tot) evaluated before and 4-10 months after surgery showed marke d preoperative impairment before and significant improvement after surgery (P < 0.05). In five patients revision surgery was performed due to a progre ssive impairment of respiratory function. A vari able degree of voice breat hiness was observed after surgery; the maximum phonation time mean values w ere lower than normal and peak sound pressure levels 63 +/- 5 dB. In three cases aspiration was present in the first postoperative days, but swallowin g dysfunctions disappeared within 1 week. Subtotal arytenoidectomy with re removal of the posterior third of the true and false vocal folds was found to be a satisfactory surgical treatment for bilateral vocal cord paralysis in adduction. However, further research is still needed to define the surgi cal procedure able to balance respiratory, phonatory and sphincteric functi ons optimally.