Management of bilateral vocal fold paralysis: Experience at the Universityof Athens

The treatment of patients with vocal fold paralysis presents a challenge to the otolaryngologist-head and neck surgeon. Many techniques have been prop osed to manage individuals with unilateral or bilateral vocal fold paralysi s. We herein describe the experience of our department in dealing with bila teral vocal fold paralysis. At the University of Athens, patients presentin g with symptomatic bilateral paralysis are treated with a posterior cordect omy by using the CO2 or KTP-532 laser. During the last 5 years, we have tre ated 20 patients (8 men and 12 women) presenting with symptomatic bilateral vocal fold paralysis. For augmentation of the glottic airway, a modificati on of Kashima's cordotomy was used, completing a partial posterior cordecto my of one or both true and false vocal folds with the CO, laser(15 patients ) and the KTP-532 laser (5 patients). An elective tracheotomy was done befo re the cordotomy. Complications, such as infection, strider, or dyspnea, we re minimal. Although no objective voice analysis was performed, all patient s were able to communicate without any phonation device and were satisfied with the result of the surgery. When compared with other techniques, the ad vantages offered by the posterior cordectomy included rapidity and simplici ty in concept, reliability of outcome, short hospitalization, low risk of c omplications, and the possibility for revision when necessary (posterior co rdectomy). From the successful postsurgical results of this study, it can b e concluded that the posterior cordectomy is a reliable treatment option fo r the management of patients with bilateral vocal fold paralysis.