Skip to main content
SpringerLink
Log in

Surgical Treatment of Bilateral Vocal Fold Immobility

  • Chapter
  • First Online:
Neurolaryngology

  • 898 Accesses

Abstract

Bilateral vocal fold immobility (BVFI) has several aetiologies. Vocal fold paralysis affecting both folds due to recurrent laryngeal nerve (RLN) injury is the commonest cause for bilateral vocal fold immobility syndrome. Other causes include ankylosis resulting in joint arthrodesis.

Patients present paradoxically with a breathy voice that improves with time at the expense of the respiratory function. Management of patients in acute stridor can be medical, surgical or both. Treatment of patients with BVFI is challenging. Tracheotomy has been the historic fail-safe treatment. Modern technology has allowed for the advancement of microsurgical techniques using the operating microscope, endoscopes, lasers and jet ventilation. Laryngeal airway enlargement procedures have gained greater acceptance and are now more commonly undertaken. Surgical techniques to widen the glottic aperture are being performed more commonly. There is a trade-off between the airway aperture, voice and laryngeal competence in limiting aspiration. Nerve reinnervation and pacing techniques are becoming more widely practised.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 149.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 149.00
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Feehery JM, Pribitkin EA, Heffelfinger RN, Lacombe VG, Lee D, Lowry LD, Keane WM, Sataloff RT. The evolving etiology of bilateral vocal fold immobility. J Voice. 2003;17(1):76–81.

    Article  PubMed  Google Scholar 

  2. Benninger MS, Gillen JB, Altaian JS. Changing etiology of vocal fold immobility. Laryngoscope. 1998;108(9):1346–50.

    Article  CAS  PubMed  Google Scholar 

  3. Kleinsasser O, Nolte E. Report on the indication, technique and functional results of endolaryngeal arytenoidectomy and submucous partial chordectomy in bilateral paralysis of vocal cord (author’s transl). Laryngo-Rhino-Otologie. 1981;60(8):397–401.

    Article  CAS  Google Scholar 

  4. Leon X, Venegas MP, Orús C, Quer M, Maranillo E, Sañudo JR. Glottic immobility: retrospective study of 229 cases. Acta Otorrinolaringol Esp. 2000;52(6):486–92.

    Article  Google Scholar 

  5. Sessions DG, Ogura JH, Heeneman H. Surgical management of bilateral vocal cord paralysis. Laryngoscope. 1976;86(4):559–66.

    Article  CAS  PubMed  Google Scholar 

  6. Barach AL. The use of helium in the treatment of asthma and obstructive lesions in the larynx and trachea. Ann Intern Med. 1935;9(6):739–65.

    Article  CAS  Google Scholar 

  7. Plouin-Gaudon I, Lawson G, Jamart J, Remacle M. Subtotal carbon dioxide laser arytenoidectomy for the treatment of bilateral vocal fold immobility: long-term results. Ann Otol Rhinol Laryngol. 2005;114(2):115–21.

    Article  PubMed  Google Scholar 

  8. Woodman DG. A modification of the extralaryngeal approach to arytenoidectomy for bilateral abductor paralysis. Arch of Otol Head Neck Surg. 1946;43(1):63.

    Article  CAS  Google Scholar 

  9. Thornell WC. Intralaryngeal approach for arytenoidectomy in bilateral abductor paralysis of the vocal cords: a preliminary report. Arch Otolaryngol. 1948;47(4):505–8.

    Article  CAS  PubMed  Google Scholar 

  10. Kleinsasser O. Endolaryngeale Arytenoidektomie und submuköse Hemichordektomie zur Erweiterung der Glottis bei bilateraler Abduktorenparese. Msch Ohr Laryngorhinol. 1968;102:443–6.

    CAS  Google Scholar 

  11. Eckel HE, Sittel C. Morphometric studies at the level of the glottis as a principle in larynx enlarging microlaryngoscopic surgical procedures in bilateral recurrent nerve paralysis. Laryngo-Rhino-Otologie. 1994;73(8):417–22.

    Article  CAS  PubMed  Google Scholar 

  12. Eckel HE, Vössing M. Endolaryngeal surgical procedures in glottis expansion in bilateral recurrent nerve paralysis. Laryngorhinootologie. 1996;75(4):215–22.

    Article  CAS  PubMed  Google Scholar 

  13. Wassermann K, Gitt A, Weyde J, Eckel HE. Lung function changes and exercise-induced ventilatory responses to external resistive loads in normal subjects. Respiration. 1995;62(4):177–84.

    Article  CAS  PubMed  Google Scholar 

  14. Wassermann K, Koch A, Warschkow A, Mathen F, Müller-Ehmsen J, Eckel HE. Measuring in situ central airway resistance in patients with laryngotracheal stenosis. Laryngoscope. 1999;109(9):1516–20.

    Article  CAS  PubMed  Google Scholar 

  15. Wassermann K, Eckel HE. Stenoses of the upper airways. Lung function, local resistance and load compensation. A review. HNO. 1999;47(11):947–56.

    Article  CAS  PubMed  Google Scholar 

  16. Woodson G. Arytenoid abduction: indications and limitations. Ann Otol Rhinol Laryngol. 2010;119(11):742–8.

    PubMed  Google Scholar 

  17. Eckel HE, Lichtenberger G. Glottic airway stenosis. In:Surgery of larynx and trachea. Berlin Heidelberg: Springer; 2010. p. 125–35.

    Google Scholar 

  18. Eckel HE, Sittel C. Bilateral recurrent laryngeal nerve paralysis. HNO. 2001;49(3):166–79.

    Article  CAS  PubMed  Google Scholar 

  19. Carneiro-Pla D, Miller BS, Wilhelm SM, Milas M, Gauger PG, Cohen MS, Solorzano CC. Feasibility of surgeon-performed transcutaneous vocal cord ultrasonography in identifying vocal cord mobility: a multi-institutional experience. Surgery. 2014;156(6):1597–604.

    Article  PubMed  Google Scholar 

  20. Leitersdorfer S, Lichtenberger G, Bihari A, Kovacs I. Evaluation of the lung function test in reversible glottis-dilating operations. Eur Arch Otorhinolaryngol. 2005;262(4):289–93.

    Article  CAS  PubMed  Google Scholar 

  21. Leitersdorfer S, Lichtenberger G, Kovacs I. Assessment of the results of glottis-dilating operations using lung function tests. Eur Arch Otorhinolaryngol. 2002;259(2):57–9.

    Article  CAS  PubMed  Google Scholar 

  22. Weddell G, Feinstein B, Pattle RE. The electrical activity of voluntary muscle in man under normal and pathological conditions. Brain. 1944;67:178–257.

    Article  Google Scholar 

  23. Rickert SM, Childs LF, Carey BT, Murry T, Sulica L. Laryngeal electromyography for prognosis of vocal fold palsy: a meta-analysis. Laryngoscope. 2012;122(1):158–61.

    Article  PubMed  Google Scholar 

  24. Sataloff RT, Praneetvatakul P, Heuer RJ, Hawkshaw MJ, Heman-Ackah YD, Schneider SM, Mandel S. Laryngeal electromyography: clinical application. J Voice. 2010;24(2):228–34.

    Article  PubMed  Google Scholar 

  25. Woodson G, Weiss T. Arytenoid abduction for dynamic rehabilitation of bilateral laryngeal paralysis. Ann Otol Rhinol Laryngol. 2007;116(7):483.

    Article  PubMed  Google Scholar 

  26. Lawson G. Tracheotomy. In:Surgery of larynx and trachea. Berlin Heidelberg: Springer; 2010. p. 159–69.

    Google Scholar 

  27. Sittel C, Stennert E, Thumfart WF, Dapunt U, Eckel HE. Prognostic value of laryngeal electromyography in vocal fold paralysis. Arch Otolaryngol Head Neck Surg. 2001;127(2):155–60.

    Article  CAS  PubMed  Google Scholar 

  28. Damm M, Eckel HE, Jungehülsing M, Roth B. Management of acute inflammatory childhood stridor. Otolaryngol Head Neck Surg. 1999;121(5):633–8.

    Article  CAS  PubMed  Google Scholar 

  29. Lippert BM. Laterofixation der Stimmlippe statt Tracheotomie bei akuter beidseitiger Stimmlippenparese. Dtsch Med Wochenschr. 2002;127:917–22.

    Article  PubMed  Google Scholar 

  30. Jatzko GR, Lisborg PH, Müller MG, Wette VM. Recurrent nerve palsy after thyroid operations--principal nerve identification and a literature review. Surgery. 1994;115(2):139–44.

    CAS  PubMed  Google Scholar 

  31. Lichtenberger G. Reversible immediate and definitive lateralization of paralyzed vocal cords. Eur Arch Otorhinolaryngol. 1999;256(8):407–11.

    Article  CAS  PubMed  Google Scholar 

  32. Ejnell H, Mansson I, Bake B, Hallén O, Stenborg R, Lindstroum J. A simple operation for bilateral vocal cord paralysis. Laryngoscope. 1984;94(7):954–8.

    Article  CAS  PubMed  Google Scholar 

  33. Kirchner FR. Endoscopic lateralization of the vocal cord in abductor paralysis of the larynx. Laryngoscope. 1979;89(11):1779–83.

    Article  CAS  PubMed  Google Scholar 

  34. Oysu C, Sahin-Yilmaz A, Uslu C. Emergency endoscopic vocal cord lateralization as an alternative to tracheotomy for patients with bilateral abductor vocal cord paralysis. Eur Arch Otorhinolaryngol. 2012;269(12):2525–9.

    Article  PubMed  Google Scholar 

  35. Ezzat WF, Shehata M, Kamal I, Riad MA. Adjustable laterofixation of the vocal fold in bilateral vocal fold paralysis. Laryngoscope. 2010;120(4):731–3.

    Article  PubMed  Google Scholar 

  36. Dennis DP, Kashima H. Carbon dioxide laser posterior cordectomy for treatment of bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol. 1989;98:930–4.

    Article  CAS  PubMed  Google Scholar 

  37. Kashima HK. Bilateral vocal fold motion impairment: pathophysiology and management by transverse cordotomy. Ann Otol Rhinol Laryngol. 1991;100(9 Pt 1):717–21.

    Article  CAS  PubMed  Google Scholar 

  38. Wassermann K, Mathen F, Eckel HE. Concurrent glottic and tracheal stenoses: restoration of airway continuity in end-stage malignant disease. Ann Otol Rhinol Laryngol. 2001;110(4):349–55.

    Article  CAS  PubMed  Google Scholar 

  39. Pia F, Pisani P, Aluffi P. CO2 laser posterior ventriculocordectomy for the treatment of bilateral vocal cord paralysis. Eur Arch Otorhinolaryngol. 1999;256(8):403–6.

    Article  CAS  PubMed  Google Scholar 

  40. Reker U, Rudert H. Die modifizierte posteriore Chordektomie nach Dennis und Kashima bei der Behandlung beidseitiger Rekurrensparesen. Laryngo Rhino Otologie. 1998;77(04):213–8.

    Article  CAS  PubMed  Google Scholar 

  41. Eckel HE, Thumfart M, Wassermann K, Vössing M, Thumfart WF. Cordectomy versus arytenoidectomy in the management of bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol. 1994;103(11):852–7.

    Article  CAS  PubMed  Google Scholar 

  42. Hoover WB. Bilateral abductor paralysis: operative treatment by sub mucous resection of the vocal cords. Arch Otolaryngol. 1932;15(3):339–5.

    Article  Google Scholar 

  43. Jackson C. Ventriculocordectomy: a new operation for the cure of goitrous paralytic laryngeal stenosis. Arch Surg. 1922;4(2):257.

    Article  Google Scholar 

  44. Kelly JD. Surgical treatment of bilateral paralysis of the abductor muscles. Arch Otolaryngol. 1941;33(2):293–304.

    Article  Google Scholar 

  45. Lore J. Suggested operative procedure for the relief of stenosis in double abductor paralysis: an anatomic study. Ann Otol Rhinol Laryngol. 1936;45(3):679–86.

    Article  Google Scholar 

  46. Lore J Jr. An atlas of head and neck surgery. 3rd ed. Philadelphia: WB Saunders; 1988. p. 878–81.

    Google Scholar 

  47. Eskew JR, Bailey BJ. Laser arytenoidectomy for bilateral vocal cord paralysis. Otolaryngol Head Neck Surg. 1983;91(3):294–8.

    Article  CAS  PubMed  Google Scholar 

  48. Lim RY. Laser arytenoidectomy. Arch Otolaryngol. 1985;111(4):262–3.

    Article  CAS  PubMed  Google Scholar 

  49. Ossoff RH, Sisson GA, Moselle HI, Duncavage JA, Andrews PE, McMillan WG. Endoscopic laser arytenoidectomy for the treatment of bilateral vocal cord paralysis. Laryngoscope. 1984;94(10):1293–7.

    Article  CAS  PubMed  Google Scholar 

  50. Sato K, Umeno H, Nakashima T. Laser arytenoidectomy for bilateral median vocal fold fixation. Laryngoscope. 2001;111(1):168–71.

    Article  CAS  PubMed  Google Scholar 

  51. Remacle M, Lawson G, Mayne A, Jamart J. Subtotal carbon dioxide laser arytenoidectomy by endoscopic approach for treatment of bilateral cord immobility in adduction. Ann Otol Rhinol Laryngol. 1996;105(6):438–45.

    Article  CAS  PubMed  Google Scholar 

  52. Reidenbach MM. Anatomical bases of glottic widening surgery related to arytenoidectomy. Clin Anat. 1999;12(2):94–102.

    Article  CAS  PubMed  Google Scholar 

  53. Lichtenberger G. Laryngeal microsurgical laterofixation of paralyzed vocal cords using a new suture instrument. Laryngorhinootologie. 1989;68(12):678–82.

    Article  CAS  PubMed  Google Scholar 

  54. Lichtenberger G, Toohill RJ. Technique of endo-extralaryngeal suture lateralization for bilateral abductor vocal cord paralysis. Laryngoscope. 1997;107(9):1281–3.

    Article  CAS  PubMed  Google Scholar 

  55. Lichtenberger G, Toohill RJ. The endo-extralaryngeal needle carrier. Otolaryngol Head Neck Surg. 1991;105(5):755–6.

    Article  CAS  PubMed  Google Scholar 

  56. Tucker HM. Human laryngeal reinnervation. Laryngoscope. 1976;86(6):769–79.

    Article  CAS  PubMed  Google Scholar 

  57. Tucker HM. Human laryngeal reinnervation: long-term experience with the nerve-muscle pedicle technique. Laryngoscope. 1978;88(4):598–604.

    Article  CAS  PubMed  Google Scholar 

  58. Tucker HM, Harvey J, Ogura JH. Vocal cord remobilization in the canine larynx. Arch Otolaryngol. 1970;92(6):530–3.

    Article  CAS  PubMed  Google Scholar 

  59. Maniglia AJ, Dodds B, Sorensen K, Katirji MB, Rosenbaum ML. Newer technique of laryngeal reinnervation: superior laryngeal nerve (motor branch) as a driver of the posterior cricoarytenoid muscle. Ann Otol Rhinol Laryngol. 1989;98(11):907–9.

    Article  CAS  PubMed  Google Scholar 

  60. Tóth A, Szócs A, Harasztosi C, Matesz K, Pucsok K, Mikó I, Sziklai I. Intrinsic laryngeal muscle reinnervation with nerve-muscle pedicle. Otolaryngol Head Neck Surg. 2005;132(5):701–6.

    Article  PubMed  Google Scholar 

  61. Crumley RL. Experiments in laryngeal reinnervation. Laryngoscope. 1982;92(S30):1–27.

    Article  CAS  PubMed  Google Scholar 

  62. Crumley RL. Phrenic nerve graft for bilateral vocal cord paralysis. Laryngoscope. 1983;93(4):425–8.

    Article  CAS  PubMed  Google Scholar 

  63. Zheng H, Zhou S, Li Z, Chen S, Zhang S, Huang Y, Geng L. Reinnervation of the posterior cricoarytenoid muscle by the phrenic nerve for bilateral vocal cord paralysis in humans. Zhonghua Er Bi Yan Hou Ke Za Zhi. 2002;37(3):210–4.

    PubMed  Google Scholar 

  64. Marie JP. Nerve reconstruction. In:Surgery of larynx and trachea. Berlin Heidelberg: Springer; 2010. p. 279–94.

    Google Scholar 

  65. Bergmann K, Gerhardt HJ, Warzel H, Eckhardt HU, Hopstock U, Hermann V. Long-term implantation of a system of electrical stimulation of paralyzed laryngeal muscles in dogs. Laryngoscope. 1988;98(4):455–9.

    Article  CAS  PubMed  Google Scholar 

  66. Obert PM, Young KA, Tobey DN. Use of direct posterior cricoarytenoid stimulation in laryngeal paralysis. Arch Otolaryngol. 1984;110(2):88–92.

    Article  CAS  PubMed  Google Scholar 

  67. Zealear DL, Rainey CL, Herzon GD, Netterville JL, Ossoff RH. Electrical pacing of the paralyzed human larynx. Ann Otol Rhinol Laryngol. 1996;105(9):689–93.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, Ng Teng Fong General Hospital, National University Health System, 1 Jurong East Street 21, Singapore, 609606, Singapore

    Vyas M. N. Prasad

  2. Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia

    Mohammed I. Almohizea

  3. Department of ORL-Head and Neck Surgery, CHL-Eich, Medical Center 3rd Floor, 76 Rue d’Eich, Luxembourg, L-1460, Luxembourg

    Marc Remacle

Authors
  1. Vyas M. N. Prasad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohammed I. Almohizea
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marc Remacle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vyas M. N. Prasad .

Editor information

Editors and Affiliations

  1. Department of Otorhinolaryngology/Head and Neck Surgery, Clinical Centre Stuttgart, Stuttgart, Germany

    Christian Sittel

  2. Department of Otorhinolaryngology and Institute of Phoniatry and Pedaudiology, Jena University Hospital, Jena, Germany

    Orlando Guntinas-Lichius

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Prasad, V.M.N., Almohizea, M.I., Remacle, M. (2018). Surgical Treatment of Bilateral Vocal Fold Immobility. In: Sittel, C., Guntinas-Lichius, O. (eds) Neurolaryngology. Springer, Cham. https://doi.org/10.1007/978-3-319-61724-4_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-61724-4_13

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-61722-0

  • Online ISBN: 978-3-319-61724-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation