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. 2018 Jul;33(5):1115-1121.
doi: 10.1007/s10103-018-2478-9. Epub 2018 Mar 20.

Outcomes of CO2 laser-assisted posterior cordectomy in bilateral vocal cord paralysis in 132 cases

Joanna Jackowska  1 , Elisabeth V Sjogren  2 , Anna Bartochowska  3 , Hanna Czerniejewska-Wolska  4 , Krzysztof Piersiala  5 , Malgorzata Wierzbicka  1
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Outcomes of CO2 laser-assisted posterior cordectomy in bilateral vocal cord paralysis in 132 cases

Joanna Jackowska et al. Lasers Med Sci. 2018 Jul.

Abstract

The purpose of the study was to assess the role of laser-assisted posterior cordectomy in the management of patients with bilateral vocal cord paralysis. We aimed an analysis of 132 consecutive patients treated by CO2 laser posterior cordectomy, aged 38-91, 31% tracheotomized on admission. Cordectomy was performed under microlaryngoscopy using CO2 laser (Lumenis AcuPulse 40 CO2 laser, wavelength 10.6 μm, Lumenis Ltd., Yokneam, Israel). We looked at the number of laser glottic procedures necessary to achieve decannulation in tracheotomized patients and to achieve respiratory comfort in non-tracheotomized subjects and we evaluated the two groups for differences in patient characteristics. In tracheotomized patients, we also assessed factors affecting the success of decannulation and we evaluated the impact of tracheotomy on patients' lives. Decannulation was performed in 63% of tracheotomized patients. In terms of the number of procedures, 54% (14), 19% (5), and 27% (7) tracheotomized vs. 74% (61), 24% (20), and 2% (2) non-tracheotomized subjects underwent one, two, or three procedures, respectively. In the group of tracheotomized patients who were successfully decannulated, the number of multiple laser-assisted procedures was significantly higher than in the group of non-tracheotomized subjects with respiratory comfort after treatment (p = 0.04). Advanced age (> 66 years), comorbidities (diabetes, gastroesophageal reflux disease (GERD)), multiple thyroid surgeries, and tracheotomy below the cricoid cartilage were found to decrease the likelihood of successful decannulation. Posterior cordectomy is a simple method allowing for airway improvement and decannulation in patients with bilateral vocal cord paralysis. It is less effective in tracheotomized subjects with diabetes or GERD, older than 66 years old, after two or more thyroidectomies.

Keywords: Glottis; Larynx; Laser; Vocal fold paralysis.

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Conflict of interest statement

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of Poznan University of Medical Sciences and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by Bioethical Committee of Poznan University of Medical Sciences.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

All patients provided written informed consent prior to the surgery.

Figures

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Fig. 1
The study group
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