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Unilateral transverse cordotomy for bilateral abductor vocal fold immobility

Published online by Cambridge University Press:  18 July 2012

J M Bernstein ,
S M Jones  and
P H Jones
J M Bernstein*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
S M Jones
Affiliation:
Department of Speech, Voice and Swallowing, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
P H Jones
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
*
Address for correspondence: Mr Jonathan M Bernstein, Specialist Registrar, Otolaryngology – Head and Neck Surgery, c/o Department of Otolaryngology – Head and Neck Surgery, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital, Southmoor Road, Manchester M23 9LT, UK Fax: +44 (0)161 446 8111 E-mail: jonathan.bernstein@doctors.org.uk
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Abstract

Objective:

We present a case series with airway compromise due to bilateral abductor vocal fold paralysis or fixation, treated with unilateral transverse cordotomy.

Methods:

Of eight consecutive patients with dyspnoea due to bilateral paramedian vocal fold immobility, seven underwent unilateral transverse cordotomy between August 2006 and April 2010 at University Hospital of South Manchester, UK. Airway and voice outcomes were compared before and after surgery.

Results:

All seven treated cases derived subjective airway function improvement; there was no aspiration. The eighth case had inadequate access. None of the seven treated patients required contralateral cordotomy or permanent tracheostomy. One treated case required a temporary tracheostomy; unilateral transverse cordotomy facilitated eventual decannulation. Two patients died of cancer at five and six weeks, variously. At a mean follow up of 22 months, four cases showed unchanged or slightly worse Voice Symptom Scale and Grade-Roughness-Breathiness-Asthenia-Strain scale scores.

Conclusion:

In patients with bilateral abductor vocal fold immobility, unilateral transverse cordotomy results in improved dyspnoea with either no voice change or only slight worsening. This is a more conservative procedure than bilateral transverse cordotomy, with the potential for better preservation of voice and breath support.

Keywords

Vocal Cord ParalysisCordotomyLarynxSurgical Procedures, Operative
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 9 , September 2012 , pp. 913 - 917
Copyright
Copyright © JLO (1984) Limited 2012

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Footnotes

Presented as a poster at Laryngology 2011, 20–22 June 2011, London, UK, and orally at the North of England Otolaryngology Society, 24 September 2011, Brighouse, UK

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