title: Suture lateralization in patients with bilateral vocal fold paralysis.
abstract: OBJECTIVE
  To introduce a simplified suture lateralization (SL) technique to treat patients with bilateral vocal fold paralysis (BVFP).
  
  
  METHODS
  A retrospective study of surgical procedures by manual chart review.
  
  
  METHODS
  The proposed endoscopic SL procedure was used for 20 patients operated on for BVFP between 2007 and 2013, with three attempts to remove a tracheostomy tube and 17 attempts to resolve the dyspnea. An adjustment procedure was also used to correct any excessive lateralization according to the individual's clinical symptoms, such as intolerable aspiration after SL in elderly patients and excessive breathiness of voice in socially active patients. St George's respiratory questionnaire was used to subjectively evaluate the efficacy of lateralization of vocal folds. Pulmonary function test with flow-volume loop was used to objectively evaluate the improvement of BVFP-related upper airway obstruction after surgery. Phonatory ability tests were also used to evaluate the degree of deterioration of voice quality.
  
  
  RESULTS
  Twenty patients underwent 22 episodes of SL. Two adjustment procedures were performed to correct excessive breathiness of voice or intolerable aspiration. Respiration was adequate in all 19 patients without artificial airways. Voice quality was socially acceptable in 19 of the patients and even equal to preoperative voice quality in 14 of them. Temporary mild aspiration occurred in 18 patients only in the first few days after the procedure. One decannulation failure and refusing adjustment procedure occurred in one elderly patient. All the patients were followed up for surgical outcomes for at least 9 and 33 months on average.
  
  
  CONCLUSIONS
  SL is a simple, reversible, and minimally invasive reconstructive procedure for patients with BVFP. Our study supported its applicability for selected patients.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddist Tzu Chi Medical Foundation, New Taipei City, Taiwan, Republic of China; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Tzu-Chi Univercity, Hualien, Taiwan, Republic of China; Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China. Electronic address: wfs19582001@yahoo.com.tw.
authors.forename: Wan-Fu
authors.initials: WF
authors.lastname: Su
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Shao-Cheng
authors.initials: SC
authors.lastname: Liu
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddist Tzu Chi Medical Foundation, New Taipei City, Taiwan, Republic of China; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Tzu-Chi Univercity, Hualien, Taiwan, Republic of China.
authors.forename: Wei-Sheng
authors.initials: WS
authors.lastname: Tang
authors.affiliation: Division of Pulmonary Medicine, Taipei Tzu Chi Hospital, Buddist Tzu Chi Medical Foundation, New Taipei City, Taiwan, Republic of China; Division of Pulmonary Medicine, School of Medicine, Tzu-Chi Univercity, Hualien, Taiwan, Republic of China.
authors.forename: Mei-Chen
authors.initials: MC
authors.lastname: Yang
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
authors.forename: Yuan-Yung
authors.initials: YY
authors.lastname: Lin
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Taipei Tzu Chi Hospital, Buddist Tzu Chi Medical Foundation, New Taipei City, Taiwan, Republic of China; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Tzu-Chi Univercity, Hualien, Taiwan, Republic of China.
authors.forename: Tung-Tsun
authors.initials: TT
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D058753:Laryngoplasty / Q000379:methods*; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014827:Vocal Cords / Q000503:physiopathology / Q000601:surgery*; D014833:Voice Quality
keywords: Adjustment procedure; Bilateral vocal fold paralysis; Laryngoplasty; Modified suture lateralization; St George's respiratory questionnaire