Postoperative management of bilateral vocal cord paralysis

Abstract

Bilateral vocal cord paralysis is one of the most severe complications of anterior neck surgery. Although a rare complication, it imparts a massive impact on affected patients. While stabilization of the airway to provide adequate ventilation is the initial primary concern, the management of bilateral vocal fold mobility impairment remains an unsatisfactory compromise between voice, breathing, and swallowing. The lack of an ideal solution is aptly illustrated by the abundance of technical reports in the literature over the last 100 years. Current techniques restore airway patency at the cost of worse glottic closure and vocal quality. Therapy tends to be grouped into immediate interventions in the acute setting of respiratory compromise, and long-term interventions aimed restoring glottic patency after the airway has been acutely stabilized. The majority of procedures currently performed are aimed at physically enlarging the laryngeal lumen. Although an area of rapid progress and active development, laryngeal reinnervation has yielded rare mobility gains. Another promising line of research is of implantable stimulators, which maintain mobility and voice patterns, but these have not yet become a mainstream option available to patients outside of experimental protocols.