Functional results of endoscopic arytenoid abduction lateropexy for bilateral vocal fold palsy

Abstract

Purpose: Endoscopic arytenoid abduction lateropexy (EAAL) is a reliable surgical solution for the minimally invasive treatment of bilateral vocal fold palsy (BVFP), providing a stable airway by the lateralization of the arytenoid cartilages with a simple suture. The nondestructive manner of the intervention theoretically leads to higher regeneration potential, thus better voice quality. The study aimed to investigate the respiratory and phonatory outcomes of this treatment concept.

Methods: 61 BVFP patients with significant dyspnea associated with thyroid/parathyroid surgery were treated by unilateral EAAL. Jitter, Shimmer, Harmonics to Noise Ratio, Maximum Phonation Time, Fundamental frequency, Voice Handicap Index, Dysphonia Severity Index, Friedrich's Dysphonia Index, Global-Roughness-Breathiness scale, Quality of Life, and Peak Inspiratory Flow were evaluated 18 months after EAAL.

Results: All patients had a stable and adequate airway during the follow-up. Ten patients (16.4%) experienced complete bilateral motion recovery with objective acoustic parameters in the physiological ranges. Most functional results of the 13 patients (21.3%) with unilateral recovery also reached the normal values. Fifteen patients (24.6%) had unilateral adduction recovery only, with slightly impaired voice quality. Eleven patients (18.0%) had false vocal fold phonation with socially acceptable voice. In 12 patients (19.7%) no significant motion recovery was detected on the glottic level.

Conclusion: EAAL does not interfere with the potential regeneration process and meets the most important phoniatric requirements while guaranteeing the reversibility of the procedure-therefore serving patients with transient palsy. Further, a socially acceptable voice quality and an adequate airway are ensured even in cases of permanent bilateral vocal fold paralysis.

Keywords: Bilateral vocal fold palsy; Endoscopic arytenoid abduction lateropexy; Minimally invasive surgery; Voice quality.

Fig. 1

Left-sided endoscopic arytenoid abduction lateropexy. (schematic drawing, posterior view of the larynx, the arrow shows the movement of the blade). a The built-in, curved blade is pushed through under the vocal process out to the surface of the neck, and a nonabsorbable suture thread is laced through the hole at the tip of the blade. b The doubled-over thread is pulled back with the blade, into the laryngeal cavity. c After a repeated tilting of the arytenoid cartilage, the blade (and the thread) is pushed out above the vocal process to the outer surface of the neck. d The arytenoid cartilage is stabilized in its maximally abducted position in a physiological manner

Fig. 2

Endoscopic pictures of a 42-year-old female BVFP patient. In the 8th postoperative month, the left-sided lateralizing sutures were removed due to complete bilateral motion recovery. a Inspiration; >  = small mucosal impression at the site of the removed lateralizing suture. b Phonation

Fig. 3

Endoscopic pictures of a 27-year-old female BVFP patient. a 2 weeks after EAAL on the left side. No significant vocal fold movements were observed. b, c Complete motion recovery of the left (lateralized) vocal fold. In the 11th postoperative month, the lateralizing sutures were removed. The contralateral fold remained immobile. b Inspiration; c phonation