[Bilateral vocal paralysis phonosurgery in adults]

Area of Science:

• Otolaryngology
• Laryngeal Surgery
• Airway Management

Context:

• Bilateral vocal fold paralysis presents with glottic narrowing, leading to inspiratory stridor and dysphonia.
• This condition can compromise the airway, posing a life threat.
• Surgical intervention is necessary to improve airway patency.

Purpose:

• To review surgical methods for airway enlargement in patients with bilateral vocal fold paralysis.
• To discuss the least invasive and safest procedures, including posterior transversal cordectomy (PTC) and medial arytenoidectomy (MA).
• To differentiate bilateral vocal fold paralysis from posterior commissure stenosis, as surgical approaches may overlap.

Summary:

• The primary clinical manifestation of bilateral vocal fold paralysis is the inability to abduct vocal cords, resulting in glottic space narrowing.
• Surgical options focus on gradually enlarging the airway at the glottic level.
• Posterior transversal cordectomy (PTC) and medial arytenoidectomy (MA) are presented as the least aggressive and safest procedures, with options for extended or combined techniques.
• Diagnostic differentiation from posterior commissure stenosis is crucial, although surgical procedures like MA and PTC can be applicable to both.

Impact:

• Surgical enlargement of the airway is essential for patients with bilateral vocal fold paralysis.
• Procedures like PTC and MA offer effective airway management.
• Patients must be counseled that airway improvement may come at the expense of voice quality.