Bilateral vocal paralysis phonosurgery in adults

Abstract

Ordinary clinical manifestation of the patient with bilateral vocal fold paralysis is inability of abducting the cords with a result of narrowing the glottic space, causing inspiratory stridor and mild dysphonia. Such patients can be life threatened due to narrowing airway. Some kind of surgery has to be performed on these patients in order to enlarge the airway. When we treat patients with OPG, the most reasonable way is to gradually enlarge airway at glotic level and there are several surgical methods for achieving this. The least agresive and the safest procedures are posterior transversal cordectomy (PTC) or medial arytenoidectomy (MA), after which we can perform extended versions of some of these methods or combination of both. Bilateral vocal fold paralysis has to be diagnostically different from stenosis of posterior commissure, even though the procedures such as medial arytenoidectomy, posterior transversal cordectomy and total arytenoidectomy can be performed in both cases. The patients have to be explained that the aim of the procedure is to enlarge airway to the detriment of voice quality and voice capabilities.