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Posterior Endoscopic Ventriculotomy and Cordotomy in Bilateral Vocal Fold Paralysis in Median Position
Claudiney Candido Costa1, Hugo Valter Lisboa Ramos1, Marina Nahas Dafico Bernardes2
1UNIFESP-SP, Hospital das Clínicas da Universidade Federal de Goiás (UFG), Centro Estadual de Reabilitação e Readaptação Dr. Henrique Santillo de Goiânia-GO (CRER-GO) and Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
Objectives:
Bilateral vocal fold paralysis (BVFP) is a neurological condition that compromises airway and vocal quality, besides being associated with both high mortality rates and patients' quality of life worsening. Therefore, assessing an innovative surgical approach to treat patients with bilateral median vocal fold paralysis is of great interest. We propose a combination of posterior transverse cordotomy and ventriculotomy (a similar incision in the ventricular band) aiming to avoid tracheostomy performance or allowing decannulation.
Methods:
Prospective cohort study to assess and follow up (for, at least, 18 months) patients subjected to endoscopic ventriculotomy surgery associated with posterior transverse cordotomy who present BVFP. Primary outcomes were avoidance of tracheostomy (in non-tracheostomized patients) and decannulation (in tracheostomized patients). Secondary outcomes included complications (granuloma, aspiration, bronchopneumonia, and laryngeal stenosis), need for reintervention, exercise tolerance (stair-climbing capacity), and patient-reported voice changes.
Results:
Twenty-one (21) surgeries were performed on 19 patients at mean postoperative follow-up of 64 months. Although granuloma at the vocal fold level was observed in 5 of the 21 surgeries (23.80%), all of them recorded full resolution after introducing inhaled corticosteroids, and none of the cases presented granuloma formation or aspiration capable of making oral feeding impossible. Furthermore, no bronchopneumonia case was observed. The total of 11 patients in the whole cohort did not require tracheostomy prior to surgery.
Conclusion:
Posterior endoscopic ventriculotomy combined with posterior transverse cordotomy provides full visualization of the lateral extent of the vocal fold, enabling a comprehensive cordotomy without arytenoid resection. The technique was safe, achieved high rates of tracheostomy avoidance/decannulation, and had acceptable complication and reintervention rates.
