Surgical and Functional Outcomes of Posterior Cordotomy and Partial Arytenoidectomy with CO₂ LASER in the Treatment of Bilateral Vocal Cord Immobility: A Single Institution Experience

Abstract

Background/Objectives: The purpose of this study is to investigate surgical and functional outcomes of patients affected by bilateral vocal cord immobility (BVCI) and treated with posterior cordotomy and partial arytenoidectomy. Methods: We performed a retrospective analysis on pre- and postoperative findings on a series of 27 patients affected by BVCI and treated with posterior cordotomy and partial arytenoidectomy from January 2017 to January 2022. Perceptual voice evaluations were performed using the GRBAS scale. The patients were requested to estimate the level of voice handicap experienced in their life using the Italian version of Voice Handicap Index 10 (VHI 10) questionnaire, while swallowing difficulties were self-evaluated through the Italian version of the Eating Assessment Tool (EAT-10) questionnaire. Results: Respiratory distress was evaluated according to the American Medical Research Council Dyspnoea Scale (MRC_DS) before and 1 year after the surgery. The mean of the preoperative values was 3.86 (±0.4), while 1 year after the procedure, we witnessed a significant (p ≤ 0.001) improvement, with a mean value of 1.09 (±0.9). After surgery, an overall worsening in voice quality was perceived, with a worsening in the GRBAS score. In contrast, the VHI10 does not show a statistically significant worsening. EAT 10 did not demonstrated worse scores after the surgery; rather, it showed a trend of improvement (preoperative EAT10 5.5 ± 5.8, postoperative 3.3 ± 2.9, p = 0.064). Conclusions: According to our results, posterior cordotomy plus partial arytenoidectomy is an effective procedure that provides stable and rapid respiratory improvement whilst preserving swallowing and the self-perception of voice quality.

Keywords

• bilateral vocal cord immobility
• posterior cordotomy
• partial arytenoidectomy
• vocal cord paralysis