Suture Lateralization in Patients With Bilateral Vocal Fold Paralysis

Summary Objectives To introduce a simplified suture lateralization (SL) technique to treat patients with bilateral vocal fold paralysis (BVFP). Study Design A retrospective study of surgical procedures by manual chart review. Methods The proposed endoscopic SL procedure was used for 20 patients oper...

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Bibliographic Details
Published in:Journal of voice 2014-09, Vol.28 (5), p.644-651
Main Authors: Su, Wan-Fu, Liu, Shao-Cheng, Tang, Wei-Sheng, Yang, Mei-Chen, Lin, Yuan-Yung, Huang, Tung-Tsun
Format: Article
Language:English
Subjects:
Adjustment procedure
Adult
Aged
Aged, 80 and over
Bilateral vocal fold paralysis
Dysphonia
Female
Follow-Up Studies
Humans
Laryngoplasty
Laryngoplasty - methods
Laryngoscopy - methods
Male
Medical Treatment
Middle Aged
Modified suture lateralization
Otolaryngology
Patients
Retrospective Studies
St George's respiratory questionnaire
Surgery
Surveys and Questionnaires
Suture Techniques - instrumentation
Sutures
Treatment Outcome
Vocal Cord Paralysis - diagnosis
Vocal Cord Paralysis - physiopathology
Vocal Cord Paralysis - surgery
Vocal cords
Vocal Cords - physiopathology
Vocal Cords - surgery
Voice Quality
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Summary:Summary Objectives To introduce a simplified suture lateralization (SL) technique to treat patients with bilateral vocal fold paralysis (BVFP). Study Design 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. Result 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. Conclusion SL is a simple, reversible, and minimally invasive reconstructive procedure for patients with BVFP. Our study supported its applicability for selected patients.
ISSN:0892-1997
1873-4588
DOI:10.1016/j.jvoice.2013.12.012