Comparison of endoscopic glottis-dilating operations.

Endoscopic glottis-dilating operations were first utilized in 1948 by Thornell, who performed an endolaryngeal arytenoidectomy. The real breakthrough in these operations was reported by Kleinsasser in 1968. There have been many modifications of the endoscopic glottis dilating operations by other authors over the past 30 years or more. These methods have brought great progress in relieving airway obstruction. However, some disadvantages have reduced the effectiveness of these operations. This study will compare the advantages and disadvantages of the previous methods and compare them to the methods based on the endo-extralaryngeal suture technique by Lichtenberger in the hope that some of the previous ineffectiveness of glottis-dilating operations can be eliminated. These recent endo-extralaryngeal suture techniques consist of two operations. The first operation performed on patients whose vocal cords were paralyzed is an irreversible operation. This was performed with and without arytenoidectomy. These operations were successful in 89 out of 94 patients. The second operation was reversible endo-extralaryngeal lateralization, which was carried out in 37 patients; of these operations, 35 were successful. The operation was performed, and, if the cords remained paralyzed, the suture was not removed. If there was evidence of a return of vocal cord function, the suture was removed, eliminating the need for further dilating operations. The author feels that these two operations are quite successful, because the medial mucous membrane of the vocal cord is preserved, and this avoids the scar and granuloma formation that are characteristic of most other glottic dilating operations.