[Carbon dioxide laser posterior ventriculocordectomy for treatment of bilateral vocal cord abductor paralysis].
Several surgical procedures have been proposed for the treatment of bilateral vocal cord abductor paralysis. All, whether conventional or microsurgical, are designed to achieve a compromise between phonation and respiration that ensures, however, good voice quality. In this study we present and discuss our preliminary results with C02 laser posterior ventriculocordectomy (PVC). This microsurgical procedure stems from the work of Chevalier-Jackson and extends the range of application of modern posterior cordectomy. Chevalier-Jackson's original idea (ventriculocordectomy) has been developed and integrated in the light of the most recent data on C02 laser posterior cordectomy. At our Institute, we have employed this technique in treating 13 patients with bilateral vocal cord abductor paralysis. The age range of these patients, 9 females and 4 males, was 33-80 years. The etiology varied: iatrogenic post-thyroidectomy in 8 cases, post-traumatic in 2, secondary to a central lesion in 3. In 3 patients a tracheostomy tube was in place upon hospitalization. Deglutition, even for fluids, was usually promptly recovered. Resting and external dyspnea improved in all those patients who had not been previously tracheotomized. It was possible to remove the tracheotomy the in two out of three cases. We found no evidence of iatrogenic glottic stenosis among our cases. In our experience, endoscopic laser posterior ventriculo-cordectomy has many advantages: the maneuvers are rapid, simple, straightforward and easy to perform; the operation is reliable and ensures adequate airway patency and freedom from dyspnea during daily activity. The risk of complications, such as granuloma or cicatricial stenosis, is low as as long as appropriate steps are taken before and during the operation.
Pia
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Clinica Otorinolaringoiatria, Facoltà di Medicina e Chirurgia di Novara, Università di Torino.
Pisani
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P
D000328:Adult; D000368:Aged; D002818:Cordotomy; D004724:Endoscopy; D005260:Female; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D010699:Phonation; D014826:Vocal Cord Paralysis / Q000503:physiopathology / Q000601:surgery*; D014827:Vocal Cords / Q000601:surgery*; D014833:Voice Quality
La ventricolo-cordectomia laser nel trattamento delle paralisi cordali bilaterali.