Abstract
The problem of ventilation efficiency after total laser arytenoidectomy with posterior cordectomy due to bilateral vocal cord paralysis is discussed. There are a number of views on the usefulness and efficacy of different surgical procedures aimed at widening the glottis, but the studies concerning the long-term functional results are still lacking. The objective of the study is to evaluate the durability of ventilation results in patients after laser arytenoidectomy with posterior cordectomy based on the comparison between the early postoperative results and those assessed after a period of 5 years. Thirty patients (24 females, 6 males) aged between 30 and 80 (mean 58.5) with bilateral vocal cord paralysis after thyroid surgery, who underwent laser arytenoidectomy with posterior cordectomy, were analyzed. Ventilation tests were performed immediately after the operation and 5 years later with Body-Master Laab (Jaeger). The actual and predicted values of FVC, FEF25, FEF50, FEF75, PEF, MMEF75/25, AREAEx, sRT0T, RT0T were compared and analyzed. Also, the values of the inspiratory parameters FIV1, FIF50, PIF and the coefficients FEF50/FIF50 and FIV1/FEV1 were assessed. Moreover, subjective evaluation was performed based on a questionnaire. The statistical analysis reveals a significant decrease in FIV1, FIF50, PIF and FIV1/FEV1. FEF50/FIF50 and sRT0T (actual and predicted values) increased significantly after 5 years from the operation. However, the patients did not complain nor was this tendency reflected in their answers to the questionnaire. The probable reasons for such ventilation results are discussed. The role of phoniatric rehabilitation and the time elapsed is emphasized. In general, it can be concluded that laser arytenoidectomy with posterior cordectomy is a durable and effective procedure, although the objective assessment does not fully match the patient’s subjective impression.
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Abbreviations
- FEV:
-
Forced expiratory volume
- FEF:
-
Forced expiratory flow
- PEF:
-
Peak expiratory flow
- VC:
-
Vital capacity
- MMEF:
-
Maximal mid-expiratory flow
- AREAEx :
-
Surface under the expiratory curve
- PIV:
-
Peak inspiratory volume
- PIF:
-
Peak inspiratory flow
- FIV:
-
Forced inspiratory volume
- FIF:
-
Forced inspiratory flow
- RT0T :
-
Total resistance
- sRT0T :
-
Specific total resistance
- ITGV:
-
Intrathoracic gas volume
- RV:
-
Residual volume
- TLC:
-
Total lung capacity
References
Bogaard JM, Pauw KH, Stam H, Versprille A (1985) Interpretation of changes in spirographic and flow-volume variables after operative treatment in bilateral vocal cord paralysis. Bull Eur Physiopathol Respir 21:131–135
Brown LK (1985) Static lung volumes: functional residual capacity, residual volume, and total lung capacity. In: Miller A (ed) Pulmonary function tests in clinical and occupational lung disease. Grun & Stratton, Inc., Orlando, New York, San Diego, pp 77–92
Crumley RL (1993) Endoscopic laser medial arytenoidectomy for airway management in bilateral laryngeal paralysis. Ann Otol Rhinol Laryngol 102:81–84
Dennis PD, Kashima H (1989) Carbon dioxide laser posterior cordectomy for treatment of bilateral vocal cord paralysis. Ann Otol Rhinol Laryngol 98:930–934
Dwyer J, Heeneman H (1984) Flow volume spirometry as a test for postoperative airway evaluation following arytenoidectomy. J Otolaryngol 13(5):312–314
Ejnell H, Bake B, Mansson I (1984) Spirometric indices in the assessment of laryngeal obstruction. Eur J Respir Dis 65:600–610
Eskew JR, Bailey BJ (1983) Laser arytenoidectomy for bilateral vocal cord paralysis. Otolaryngol Head Neck Surg 91:294–298
Kashima HK (1991) Bilateral vocal fold motion impairment: pathophysiology and management by transverse cordectomy. Ann Otol Rhinol Laryngol 100:717–721
Lichtenberger G (1999) Reversible immediate and definitive lateralization of paralyzed vocal cords. Eur Arch Otorhinolaryngol 256:407–411
Lim RL (1985) Laser arytenoidectomy. Arch Otolaryngol 111:262–263
Maniecka-Aleksandrowicz B, Kukwa A, Zarnecki P (1983) Rehabilitacja glosu po operacjach rozszerzajacych glosnie. Otolaryng Pol 37:329–331
Marie JP, Keghian J, Mendel L, Gueit I, Dehesdin D (2001) Post-intubation vocal cord paralysis: the viral hypothesis. A case report. Eur Arch Otorhinolaryngol 258:283–284
Maurizi M, Paludetti G, Galli J, Cosenza A, Di Girolamo S, Ottaviani F (1999) CO2 laser subtotal arytenoidectomy and posterior true and false cordectomy in the treatment of post-bilateral fixation in adduction. Eur Arch Otorhinolaryngol 256:291–295
Miller RD, Hyatt RE (1973) Evaluation of obstructing lesions of the trachea and larynx by flow-volume loops. Am Rev Respir Dis 108:475–481
Misiolek M, Namyslowski G, Warmuzinski K, Karpe J, Rauer R, Misiolek H (2003) The influence of laser arytenoidectomy on ventilation parameters in patients with bilateral vocal cord paralysis. Eur Arch Otorhinolaryngol 260:381–385
Misiolek M, Waler J, Namyslowski G, Kucharzewski M, Podwinski A, Czecior E (2001) Recurrent nerve palsy after thyroid cancer surgery—laryngological and surgical problem. Eur Arch Otorhinolaryngol 258:460–462
Ossoff RH, Duncavage JA, Krepsi YP, Shpshay SM, Sisson GA (1990) Endoscopic laser arytenoidectomy revisited. Ann Otol Rhinol Laryngol 99:764–771
Pia F, Pisani P, Aluffi P (1999) CO2 laser posterior ventriculocordectomy for the treatment of bilateral vocal cord paralysis. Eur Arch Otorhinolaryngol 156:403–406
Plouin-Gaudon I, Lawson G, Jamart J, Remacle M (2005) Subtotal carbon dioxide laser arytenoidectomy for the treatment of bilateral vocal fold immobility: long-term results. Ann Otol Rhinol Laryngol 114:115–121
Quanjer PH (1983) Standardized lung function testing. Bull Eur Physiopathol Respir 19(suppl):1–3
Remacle M, Lawson G, Mayne A, Jamart J (1996) Subtotal carbon dioxide laser arytenoidectomy by endoscopic approach for treatment of bilateral cord immobility in adduction. Ann Otol Rhinol Laryngol 105:438–445
Szmeja Z, Wojtowicz JG (1999) Laser arytenoidectomy in treatment of bilateral vocal cord paralysis. Eur Arch Otorhinolaryngol 256:388–389
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Misiolek, M., Ziora, D., Namyslowski, G. et al. Long-term results in patients after combined laser total arytenoidectomy with posterior cordectomy for bilateral vocal cord paralysis. Eur Arch Otorhinolaryngol 264, 895–900 (2007). https://doi.org/10.1007/s00405-007-0288-y
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DOI: https://doi.org/10.1007/s00405-007-0288-y