A functional approach to lateral fixation in bilateral abductor cord paralysis

A modification of the Clerf arytenoidopexy treatment for bilateral vocal cord paralysis is described; it consists of an external approach with complete unilateral division of the posterior cricoarytenoid and interarytenoid muscles. The entire arytenoid is next mobilized and tilted laterally, then fixed into position along the posterior margin of the thyroid cartilage by two or three permanent retention sutures. Careful placement of these sutures renders the laryngeal mucosa maximally undisturbed and is largely responsible for the predictable results achieved with this technique. During the past 2 years, 18 patients received this static procedure, and 17 of 18 (94%) required a tracheotomy as part of the treatment because of a uniformly severe degree of glottic obstruction. All tracheotomy patients have been permanently decannulated (on an average) 14 days after surgery. The evaluation of each patient included pre- and post-operative measurements of airway resistance that correlated well with the width of the posterior commissure, and proved invaluable in successful decannulation efforts.