Unilateral transverse cordotomy for bilateral abductor vocal fold immobility.
OBJECTIVE
We present a case series with airway compromise due to bilateral abductor vocal fold paralysis or fixation, treated with unilateral transverse cordotomy.


METHODS
Of eight consecutive patients with dyspnoea due to bilateral paramedian vocal fold immobility, seven underwent unilateral transverse cordotomy between August 2006 and April 2010 at University Hospital of South Manchester, UK. Airway and voice outcomes were compared before and after surgery.


RESULTS
All seven treated cases derived subjective airway function improvement; there was no aspiration. The eighth case had inadequate access. None of the seven treated patients required contralateral cordotomy or permanent tracheostomy. One treated case required a temporary tracheostomy; unilateral transverse cordotomy facilitated eventual decannulation. Two patients died of cancer at five and six weeks, variously. At a mean follow up of 22 months, four cases showed unchanged or slightly worse Voice Symptom Scale and Grade-Roughness-Breathiness-Asthenia-Strain scale scores.


CONCLUSIONS
In patients with bilateral abductor vocal fold immobility, unilateral transverse cordotomy results in improved dyspnoea with either no voice change or only slight worsening. This is a more conservative procedure than bilateral transverse cordotomy, with the potential for better preservation of voice and breath support.
Department of Otolaryngology - Head and Neck Surgery, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK. jonathan.bernstein@doctors.org.uk
J M
JM
Bernstein
S M
SM
Jones
P H
PH
Jones
D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology / Q000601:surgery*; D004417:Dyspnea / Q000209:etiology; D004564:Electrocoagulation; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D012720:Severity of Illness Index; D014139:Tracheostomy; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000150:complications / Q000601:surgery*; D014832:Voice Disorders / Q000517:prevention & control; D014833:Voice Quality / Q000502:physiology