Long-Term Interventions for Bilateral Vocal Fold Paralysis: Endoscopic and Open Procedures

Abstract

Bilateral vocal fold paralysis (BVFP) usually refers to the immobility of both vocal folds, usually due to a neurologic etiology. It is often characterized by inspiratory or biphasic stridor with normal phonation. This is due to narrowing of the glottic airway with both vocal folds in the paramedian position. The dyspnea associated with BVFP can be life-threatening, requiring emergent intervention such as a tracheostomy. In most cases, patients are stable, and management is focused on creating a safe, tracheostomy-free airway while maintaining an intricate balance between airway, deglutition, and phonation. Often, a series of surgical procedures is needed to provide an adequate glottic airway while maintaining a passable voice. Surgical interventions include endoscopic techniques such as cordotomy, arytenoidectomy, and suture lateralization procedures, as well as open techniques such as posterior cricoid split with graft and tracheostomy. The outcome of tracheostomy and decannulation may be used as metrics to assess severity of disease and successful surgical therapy. Few studies have looked at success rates of these procedures, but generally less invasive procedures are attempted first; if unsuccessful, the patient and surgeon may decide more invasive procedures such as posterior cricoid split with rib graft to improve glottic airway and achieve decannulation. The surgical techniques, with their indications, advantages, complications, and success rates, when available, will be illustrated in this chapter.