Endoscopic Laser Cordotomy Versus Coblator Cordectomy: Our Experience in Managing Bilateral Abductor Paralysis

Abstract

Introduction: Bilateral abductor vocal fold paralysis is a potentially challenging surgical entity. Various surgical options have been proposed for managing this condition. The present study aims to share our experience of using two established surgical modalities in managing this condition. Study design: Retrospective review. Setting: Tertiary health care center. Materials and methods: Twenty-three consecutive patients meeting inclusion criteria undergoing posterior cordotomy using CO2 laser (n = 9) and posterior cordectomy using coblator (n = 14) were included in this study. Preoperative subjective voice analysis was done and compared with measurements at 6 months post procedure. Parameters studied included voice handicap index (VHI), the need for repeat procedures, the effect of decannulation and subjective improvement in respiratory distress. Results: In all the patients undergoing these surgical procedures, there was a significant improvement in the airway as adjudged by the postoperative subjective improvement in respiratory distress (in five non-tracheostomized patients) and uneventful decannulation (in 18 tracheostomized patients). However, there was no statistically significant difference in either of the two techniques. The postoperative VHI scores showed no statistically significant difference with the preoperative assessment using either of the techniques. Two of the patients in the CO2 laser group and one patient in the coblator group required the procedure to be repeated owing to recurrence of respiratory distress. Conclusion: Both CO2 laser-assisted posterior cordotomy and coblator assisted posterior cordectomy are safe and efficacious options for the management of compromised airway secondary to bilateral abductor paralysis of vocal folds with comparable outcomes.