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COMPARISON OF LATERALIZATION THYROPLASTY AND LASER CORD WEDGE RESECTION IN TERMS OF VOICE QUALITY IN PATIENTS WITH BILATERAL ABDUCTOR VOCAL CORD PARALYSIS

Year 2019, , 343 - 348, 31.12.2019
https://doi.org/10.16899/jcm.625978

Abstract

Abstract

Background/Aims: It was aimed to compare
lateralization thyroplasty with laser cord wedge resection in terms of
postoperative voice analysis, duration of hospital stay, tracheotomy rate, and
decannulation time in patients
with
bilateral abductor vocal cord paralysis. 

Methods: A
total of 37 patients who presented to our department with bilateral abductor
vocal cord paralysis between February 2005 and February 2009 were enrolled in
this prospective study
. External
arytenoid lateralization (lateralization thyroplasty) was randomly performed in
22 patients and laser posterior cordotomy was performed in 15 patients. Fifteen
healthy volunteers were assigned to the control group. Postoperative 6th
month maximum phonation time (MPT), S/Z ratio, and the results of objective
voice analysis [mean frequency perturbation (jitter), mean amplitude
perturbation (shimmer), mean fundamental frequency (fo), and NHR (noise to
harmonic ratio)] were compared between the two groups and the control group.
Decannulation time, patient tracheotomy status, and duration of hospital stay
were also recorded.

Results: The mean
postoperative MPT decreased but S/Z ratio increased in both patient groups
compared to the control group. The mean MPT was shorter in the external
arytenoid lateralization group versus the laser posterior cordotomy group (p= 0.011).
There was no statistically significant difference between the external
arytenoid lateralization and laser posterior cordotomy groups in terms of mean
S/Z ratio (p= 0.306). It was observed that jitter, shimmer, and NHR values were
increased, i.e. voice quality impaired, in both patient groups. Jitter (p= 0.004),
shimmer (p<0.001), and NHR (p= 0.052) values were significantly increased in
the laser posterior cordotomy group as compared with the external arytenoid
lateralization group. No statistically significant difference was found between
the external arytenoid lateralization group and the laser posterior cordotomy
group in terms of the mean postoperative f(o) (p= 0.417), as well as for
decannulation time (p= 0.076) and duration of hospital stay (p= 2.30).

Conclusions: External arytenoid
lateralization is a more preferable technique than laser posterior cordotomy because
it preserves mucosal integrity and cord mass, which results in better voice
quality.



References

  • 1. Holinger LD, Holinger PC, Holinger PH. Etiology of bilateral vocal cord paralysis. Ann Otol 1976;85;428-36.2. Kashima HK. Bilateral vocal fold motion impairment. Pathophysiology and management by transverse cordotomy. Ann Otol 1991;100:717-213. Tucker HM. Vocal cord paralysis etiology and management Laryngoscope 1980;90:585-904. Dedo HH. Recurrent laryngeal nerve section for spastic dysphonia. Ann Otol Rhinol Laryngol. 1976;85:451–459.5. Nakamura K, Yosida T, Tsukahara K, et al. Clinical feasibility of surgeries for adductor spasmodic dysphonia: complication between thyroarytenoid myectomy and type 2 thyroplasty. J Jpn Bronchoesophogol Soc. 2009;60: 231–239.6. Su CY, Chuang HC, Tsai SS, Chiu JF. Transoral approach to laser thyroarytenoid myoneurectomy for treatment of adductor spasmodic dysphonia: short-term results. Ann Otol Rhinol Laryngol. 2007;116:11–18.7. Woodman DG. A modification of the extralaryngeal approach to arytenoidectomy for bilateral abductor paralysis. Arch Otolaryngol 1946;43:63-58. Ossof RH, Karlan MS, Sısson GA. Endoscopic laser arytenoidectomy. Laser Surg Med 1983;293-9.9. Ossof Rh, Sısson GA, Duncavage JA. Endoscopic laser arytenoidectomy for the treatment of bilateral vocal cord paralysis. Laryngoscope 1984;94;1293-7.10. Isshiki N, Tsuji DH, Yamamoto Y, Iizuka Y. Midline lateralization thyroplasty for adductor spasmodic dysphonia. Ann Otol Rhinol Laryngol. 2000;109:187–193.11. Tucker HM: Etiology and management. Laryngoscope 90: 585, 197912. Jatko G, Lisborg B, Muller M, Wette V. Recurrent nerve paralysis after thyroid operations. Nerve identification and literature review. Surgery 1994;115: 139-143.13. Ada M, Öz F, Toprak M, Öktem F, Kaytaz A, Yağız C. CO2 laser arytenoidectomy in laryngeal microsurgery. Turkish ORL Archive. 1999;37:23-6.14. King BT. A new and functioning respiratory operation for bilateral abductor cord paralysis. JAMA 1939;112:814-23.15. Kelly JD. Surgical treatment of bilateral paralysis of abductor muscles. Arch Otolaryngol 1941;33:293-304.16. Eckel HE, Thumfart M, Wasserman K, et al. Cordectomy versus arytenoidectomy in the management of bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol 1994; 103: 852-717. Thornell WC. Intralaryngeal approach for arytenoidectomy in bilateral abductor vocal cord paralysis. Arch Otolaryngol 1948;47:505-8.18. Tucker HM: The larynx. 2. Edition. Thieme medical publishers Inc. New York, 1993.19. Kirchner F. Endoscopic lateralization of the vocal cord in abductor paralysis of the larynx. Laryngoscope 1979;89:1779-1782.20. Carbon Dioxide Laser Endoscopic Posterior Cordotomy Technique for Bilateral Abductor Vocal Cord Paralysis JAMA Otolaryngol Head Neck Surg. 2013;139(4):401-404.21. Dennis DP, Kashima H. Carbon dioxide laser posterior cordectomy for treatment of bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol 1989;96:930-4.22. Maurizi M, Paludetti G, Galli J, Cosenza A, Di Girolamo S, Ottoviani F. CO2 laser subtotal arytenoidectomy and cordotomy in the treatment of post-thyroidectomy bilateral laryngeal fixation in adduction. Eur Arch Otorhinolaryngol 1999;256:291-5.23. Hans S, Vaissiere J, Crevier-Buchman L, Laccourreye O, Brasno D. Aerodynamic and acoustic parameters in CO2 laser posterior transverse cordotomy for bilateral vocal fold paralysis. Acta Otolaryngol 2000;120:330-33524. Bakır S, Tuncer Ü. In patients with bilateral vocal cord paralysis results of endoscopic posterior Cordotomy. Dicle Med J. 2006;36:178-183.25. Ünsal E. Öksüzler Ö. Özbek C. Aygenç E. Çelikkanat S. Özdem C. Thornell technique in the treatment of bilateral vocal cord paralysis. Kbbbbc 15(1):7-11, 200726. Laccaurreye O, Paz EsCovar MI, Gerhart J, et al. Co2 laser endoscopic posterior partial transverse cordotomy for bilateral paralysis of the vokal fold. Laryngoscope 1999;109;415-8.
Year 2019, , 343 - 348, 31.12.2019
https://doi.org/10.16899/jcm.625978

Abstract

References

  • 1. Holinger LD, Holinger PC, Holinger PH. Etiology of bilateral vocal cord paralysis. Ann Otol 1976;85;428-36.2. Kashima HK. Bilateral vocal fold motion impairment. Pathophysiology and management by transverse cordotomy. Ann Otol 1991;100:717-213. Tucker HM. Vocal cord paralysis etiology and management Laryngoscope 1980;90:585-904. Dedo HH. Recurrent laryngeal nerve section for spastic dysphonia. Ann Otol Rhinol Laryngol. 1976;85:451–459.5. Nakamura K, Yosida T, Tsukahara K, et al. Clinical feasibility of surgeries for adductor spasmodic dysphonia: complication between thyroarytenoid myectomy and type 2 thyroplasty. J Jpn Bronchoesophogol Soc. 2009;60: 231–239.6. Su CY, Chuang HC, Tsai SS, Chiu JF. Transoral approach to laser thyroarytenoid myoneurectomy for treatment of adductor spasmodic dysphonia: short-term results. Ann Otol Rhinol Laryngol. 2007;116:11–18.7. Woodman DG. A modification of the extralaryngeal approach to arytenoidectomy for bilateral abductor paralysis. Arch Otolaryngol 1946;43:63-58. Ossof RH, Karlan MS, Sısson GA. Endoscopic laser arytenoidectomy. Laser Surg Med 1983;293-9.9. Ossof Rh, Sısson GA, Duncavage JA. Endoscopic laser arytenoidectomy for the treatment of bilateral vocal cord paralysis. Laryngoscope 1984;94;1293-7.10. Isshiki N, Tsuji DH, Yamamoto Y, Iizuka Y. Midline lateralization thyroplasty for adductor spasmodic dysphonia. Ann Otol Rhinol Laryngol. 2000;109:187–193.11. Tucker HM: Etiology and management. Laryngoscope 90: 585, 197912. Jatko G, Lisborg B, Muller M, Wette V. Recurrent nerve paralysis after thyroid operations. Nerve identification and literature review. Surgery 1994;115: 139-143.13. Ada M, Öz F, Toprak M, Öktem F, Kaytaz A, Yağız C. CO2 laser arytenoidectomy in laryngeal microsurgery. Turkish ORL Archive. 1999;37:23-6.14. King BT. A new and functioning respiratory operation for bilateral abductor cord paralysis. JAMA 1939;112:814-23.15. Kelly JD. Surgical treatment of bilateral paralysis of abductor muscles. Arch Otolaryngol 1941;33:293-304.16. Eckel HE, Thumfart M, Wasserman K, et al. Cordectomy versus arytenoidectomy in the management of bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol 1994; 103: 852-717. Thornell WC. Intralaryngeal approach for arytenoidectomy in bilateral abductor vocal cord paralysis. Arch Otolaryngol 1948;47:505-8.18. Tucker HM: The larynx. 2. Edition. Thieme medical publishers Inc. New York, 1993.19. Kirchner F. Endoscopic lateralization of the vocal cord in abductor paralysis of the larynx. Laryngoscope 1979;89:1779-1782.20. Carbon Dioxide Laser Endoscopic Posterior Cordotomy Technique for Bilateral Abductor Vocal Cord Paralysis JAMA Otolaryngol Head Neck Surg. 2013;139(4):401-404.21. Dennis DP, Kashima H. Carbon dioxide laser posterior cordectomy for treatment of bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol 1989;96:930-4.22. Maurizi M, Paludetti G, Galli J, Cosenza A, Di Girolamo S, Ottoviani F. CO2 laser subtotal arytenoidectomy and cordotomy in the treatment of post-thyroidectomy bilateral laryngeal fixation in adduction. Eur Arch Otorhinolaryngol 1999;256:291-5.23. Hans S, Vaissiere J, Crevier-Buchman L, Laccourreye O, Brasno D. Aerodynamic and acoustic parameters in CO2 laser posterior transverse cordotomy for bilateral vocal fold paralysis. Acta Otolaryngol 2000;120:330-33524. Bakır S, Tuncer Ü. In patients with bilateral vocal cord paralysis results of endoscopic posterior Cordotomy. Dicle Med J. 2006;36:178-183.25. Ünsal E. Öksüzler Ö. Özbek C. Aygenç E. Çelikkanat S. Özdem C. Thornell technique in the treatment of bilateral vocal cord paralysis. Kbbbbc 15(1):7-11, 200726. Laccaurreye O, Paz EsCovar MI, Gerhart J, et al. Co2 laser endoscopic posterior partial transverse cordotomy for bilateral paralysis of the vokal fold. Laryngoscope 1999;109;415-8.
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Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Research
Authors

Dursun Tuzun This is me 0000-0002-8102-7939

Yusufhan Suoglu This is me 0000-0002-4547-5320

Mustafa Sitki Gozeler 0000-0002-9716-9579

Publication Date December 31, 2019
Acceptance Date October 15, 2019
Published in Issue Year 2019

Cite

AMA Tuzun D, Suoglu Y, Gozeler MS. COMPARISON OF LATERALIZATION THYROPLASTY AND LASER CORD WEDGE RESECTION IN TERMS OF VOICE QUALITY IN PATIENTS WITH BILATERAL ABDUCTOR VOCAL CORD PARALYSIS. J Contemp Med. December 2019;9(4):343-348. doi:10.16899/jcm.625978