Modified transoral CO₂ laser posterior cordotomy for bilateral vocal fold paralysis: surgical and functional outcomes

To describe the surgical and functional outcomes of modified posterior cordotomy in patients with bilateral vocal fold paralysis (BVFP), with particular attention to airway function, swallowing, and voice outcomes.

This retrospective study included 30 patients with BVFP who underwent modified posterior cordotomy between June 2017 and August 2024. Preoperative and postoperative evaluation included videolaryngoscopy and patient-reported outcome measures, including the Voice Handicap Index (VHI-30), Eating Assessment Tool-10 (EAT-10), and Airway-Dysphonia-Voice-Swallowing (ADVS) scale.

All 30 patients were women (mean age 55.53 years) who underwent modifiedposterior cordotomy for iatrogenic (100% post thyroidectomy) BVFP. Improvementswere observed in airway function ADVS (particularly A and D) and swallowing (EAT-10), with voice quality (VHI-30) showed no clinically meaningful postoperative worsening. All 7 tracheostomized patients (23%) were successfully decannulated post-surgery. PEF%(20/30 patients) showing a mean peak expiratory flow of 62.8% and a median of 64.5%(range, 35%-82%).

Modified posterior cordotomy via transoral CO₂ laser microsurgery was associated with improved airway function and swallowing outcomes, with minimal impact on voice-related quality of life, and no requirement for revision surgery in patients with bilateral vocal fold paralysis.