Endoscopic Partial Arytenoidectomy for Bilateral Vocal Fold Paralysis: Medially Based Mucosal Flap Technique.

PURPOSE: Endoscopic partial arytenoidectomy (EPA) is one of the static operations for treatment of bilateral vocal fold paralysis (BVFP). Improvement in airway may cause voice loss and aspiration. The author reports his experience on EPA using medially based mucosal flap to enlarge posterior glottis without removing any part of membranous vocal fold.
MATERIALS AND METHODS: Sixty-four consecutive patients with BVFP underwent EPA. Pre- and postoperative evaluations included Voice Handicap Index-30, aerodynamic and acoustic analysis, flow volume loops, perceptual evaluation of pre- and postoperative voice using grade, roughness, breathiness, asthenia, strain (GRBAS) scale, speech intensity, breathing ability evaluation, and functional outcome swallowing scale.
RESULTS: Nine patients had preoperative tracheotomy and one patient required postoperative tracheotomy. All tracheotomized patients were decannulated 1 month after surgery. Fifty-six patients (88%) did not report dyspnea in their daily activities and were considered satisfied with their postoperative airway; eight patients required revision: seven total arytenoidectomy and one posterior cricoid split with costal cartilage grafting. All Voice Handicap Index-30 results and all acoustic results (except fundamental frequency) increased significantly after surgery (P < 0.05). All aerodynamic analysis results (except mean airflow rate) decreased significantly after EPA (P < 0.05). Mean airflow rate increased significantly after EPA (P < 0.05). All flow volume loop parameters increased significantly after EPA (P < 0.05). Perceptual comparison of pre- and postoperative voice revealed similar grade and roughness (P > 0.05); however, increased breathiness (P < 0.05) was observed. Mean speech intensity decreased from 67 dB to 61 dB (P < 0.05). Postoperative breathing ability was significantly better. Pre- and postoperative functional outcome swallowing scales were not significantly different (P > 0.05).
CONCLUSIONS: EPA is a very successful static surgical option for BVFP. It results in comfortable airway with mild voice handicap. Postoperatively, it does not increase aspiration significantly. Endoscopic total arytenoidectomy is reserved for revision of failures.