ENDOSCOPIC POSTERIOR CORDECTOMY AND PARTIAL ARYTENOIDECTOMY FOR BILATERAL ABDUCTOR VOCAL CORD PARALYSIS

Abstract

INTRODUCTION Bilateral vocal cord paralysis is now a common vocal cord lesion. There is total interruption of recurrent laryngeal nerve impulse resulting in paralysis of intrinsic laryngeal muscles (except cricothyroid). Bilateral abductor paralysis is mostly idiopathic. Patient usually  presents with stridor and a normal voice.Vocal cords will be in paramedian position. Dennis and Kashima in 1989 performed posterior cordectomy using carbondioxide laser where wedge of membranous vocal cord was removed just anterior to vocal process. The advantages of the procedure are bloodless, adequate airway, good voice, no aspiration, no edema ,  possibility for revision, short stay in hospital, rapidity and    simplicity. CASE REPORT 72 Year male presented with chief complaints of difficulty in breathing and loud snoring for 40 years and acute exacerbation for past 20 days .He was  misdiagnosed to have bronchial asthma and was treated for the same on and off for 40 years. 20 days back his symptoms worsened following an attack of acute upper respiratory tract infection. He presented to a hospital at his native place where he was given emergency treatment and diagnosed as bilateral abductor paralysis and referred to us for further          management. Patient was in stridor at the time of                          presentation for which emergency tracheostomy was done. On detailed evaluation of larynx, both vocal cords were found to be in paramedian position with narrow glottic chink during videolaryngoscopy. A clinical diagnosis of bilateral abductor paralysis was made and the patient was planned for              Endoscopic posterior cordectomy with partial arytenoidectomy using coblator. The kashima's procedure was followed except Coblator was used instead of Laser. The patient was             decannulated on the 5th postoperative day. His airway             improved and voice restored to normal. CONCLUSION           Performing Kashima's procedure using coblation technology is really promising. Advantages of this procedure include bloodless ablation ,precise ablation of tissue with no collateral damage to adjacent tissue , no oedema of tissues around larynx and most importantly early decannulation.