European consensus on endoscopic surgery for bilateral vocal fold immobility: classification and nomenclature

Emilie A C Dronkers; Chadwan Al Yaghchi; Jerome R Lechien; Christian Sittel; Ahmed Geneid

doi:10.1007/s00405-024-09133-7

European consensus on endoscopic surgery for bilateral vocal fold immobility: classification and nomenclature

Eur Arch Otorhinolaryngol. 2025 Jan 2. doi: 10.1007/s00405-024-09133-7. Online ahead of print.

Authors

Emilie A C Dronkers¹, Chadwan Al Yaghchi², Jerome R Lechien^{3

4

5}, Christian Sittel⁶, Ahmed Geneid⁷

Affiliations

¹ Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Center, Albinusdreef 2, PO-Box 9600, 2300 RC, Leiden, The Netherlands. e.a.c.dronkers@lumc.nl.
² National Centre for Airway Reconstruction, Imperial College Healthcare NHS Trust, London, UK.
³ Department of Surgery, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium.
⁴ Department of Otorhinolaryngology and Head and Neck Surgery, School of Medicine, Foch Hospital, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
⁵ Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Brussels, Belgium.
⁶ Department of Otorhinolaryngology-Head and Neck Surgery, Klinikum Stuttgart, Stuttgart, Germany.
⁷ Department of Otolaryngology and Phoniatrics-Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

PMID: 39747669
DOI: 10.1007/s00405-024-09133-7

Abstract

Introduction: There are inconsistencies in how different endoscopic procedures to manage Bilateral Vocal Fold Immobility (BVFI) have been described in the literature. This limits our ability to compare functional outcomes. There is no unifying international terminology available that precisely describes the anatomical boundaries and extent of the different types of treatment. A pan-European consensus regarding terminology of different endoscopic surgical procedures to manage BVFI in adults was developed.

Methods: Thirty-one expert laryngologists and phoniatricians of the European Laryngological Society (ELS) or Union of the European Phoniatricians (UEP), participated in a modified Delphi process. They voted on an initial series of 13 proposed statements, including graphical visualization of different endoscopic surgical techniques for BVFI. Statements reaching > 70% of agreement in the first voting round were accepted. In the second voting round, eight revised and newly proposed statements were accepted with an increased threshold of > 80%.

Results: Fourteen statements were anonymously validated through two voting rounds. The following categories of endoscopic arytenoid and vocal fold surgery were defined: total arytenoidectomy, partial arytenoidectomy (subclassified into subtotal, anteromedial, posteromedial and superomedial), posterior cordectomy (subclassified into ligamental, transmuscular and ventriculocordectomy) and transverse cordotomy (subclassified into posterior cordotomy and ventriculocordotomy). The suffixes 'with mucosal preservation', 'with laterofixation' and 'combined procedure' were defined too.

Conclusion: This ELS-UEP consensus on endoscopic arytenoid and vocal fold surgery for BVFI provides a practical nomenclature and classification to improve reporting in literature and clinical practice and to allow comparison of functional outcomes.

Keywords: Arytenoidectomy; Bilateral; Cordectomy; Cordotomy; Immobility; Otolaryngology; Otorhinolaryngology; Posterior glottic stenosis; Vocal fold palsy.