Office-Based Blue Laser Posterior Cordectomy in Patients with Bilateral Vocal Fold Paralysis: A Novel Approach

Abstract

Objective: Bilateral vocal fold paralysis can be a disabling condition with an adverse impact on quality of life. Various glottal widening procedures to secure the airway have been described. These include total or partial arytenoidectomy with or without reinnervation, cordotomy, arytenoidopexy, and others. A review of the literature shows one case of office-based partial arytenoidectomy that was performed successfully using the thulium laser but no other in-office procedures for the treatment of bilateral vocal fold paralysis.

Study design: Retrospective case series with literature review.

Methods: This report presents two patients with bilateral vocal fold paralysis who underwent office-based blue laser posterior cordectomy. The blue laser is a new photoangiolytic laser (wavelength of 445 nm) with good hemostatic and cutting properties. The surgical technique of office-based posterior cordectomy using the blue laser is described with a review of the literature on arytenoidectomy/posterior cordectomy.

Results: Both procedures were well tolerated and patients showed marked improvement in breathing manifested by an increase in glottal gap on laryngeal examination with no worsening in voice quality. Long-term follow-up showed no interval changes in both cases.

Conclusion: The authors of this manuscript advocate office-based posterior cordectomy using the laser in patients who are at high risk for general anesthesia or who refuse to go to the operating room, and potentially for other patients.

Keywords: Blue laser; Cordectomy; Office-based laser surgery; Vocal fold paralysis.