The Effect of Preoperative Body Mass Index on Dyspnea After Endoscopic Total and Partial Arytenoidectomy for...

Endoscopic total and partial arytenoidectomy has been frequently performed with success for the static treatment of bilateral vocal fold paralysis (BVFP). The airway frequently improves at the expense of the voice after arytenoidectomy. This study was carried out to determine the possible effect of body mass index (BMI) on dyspnea index (DI) after endoscopic total and partial arytenoidectomy for BVFP.

A retrospective analysis was conducted of all 105 patients whose weight and height were recorded during arytenoidectomy and follow-up. Only primary cases were included. BMI was calculated for each patient. Surgical technique included total or partial arytenoidectomy without tracheotomy and preservation and suture of the mucosa medial to the arytenoid laterally. Membranous vocal fold was sutured posterolaterally. DI was obtained preoperatively and 1 year postoperatively. Digital still images showing the largest glottal area during inspiration were obtained from preoperative and postoperative videolaryngostroboscopy videos. Glottal area and anterior commissure angle were measured using the Fiji version of ImageJ software. Vocal fold width at the mid-membranous region was taken as 1 unit.

Ninety females and 15 males were included. Among the 98 cases, the etiology of BVFP was thyroidectomy, 5 were idiopathic, and 2 were caused by other etiologies. Twenty-seven cases had total, and 78 had partial arytenoidectomy. Glottal area and anterior commissure angle increased significantly postoperatively (P < 0.001). DI decreased significantly postoperatively (P < 0.001). Multiple linear regression revealed that postoperative DI was independently significantly affected by BMI, glottal area, and anterior commissure angle (P < 0.05). The glottal area and anterior commissure angle values of partial and total arytenoidectomy cases did not differ significantly preoperatively and postoperatively (P > 0.05).

High BMI negatively influences dyspnea in BVFP patients before and after arytenoidectomy. BVFP patients should be counseled to maintain ideal weight before and after arytenoidectomy. High BMI patients should be re--ed to lose weight.