Claudiney Candido Costa, Hugo Valter Lisboa Ramos, Marina Nahas Dafico Bernardes, Leandro Castro Velasco, Pauliana Lamounier, Onivaldo Cervantes
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引用次数: 0
Abstract
Objectives: Bilateral vocal fold paralysis (BVFP) is a neurological condition that compromises airway and vocal quality, besides being associated with both high mortality rates and patients' quality of life worsening. Therefore, assessing an innovative surgical approach to treat patients with bilateral median vocal fold paralysis is of great interest. We propose a combination of posterior transverse cordotomy and ventriculotomy (a similar incision in the ventricular band) aiming to avoid tracheostomy performance or allowing decannulation.
Methods: Prospective cohort study to assess and follow up (for, at least, 18 months) patients subjected to endoscopic ventriculotomy surgery associated with posterior transverse cordotomy who present BVFP. Primary outcomes were avoidance of tracheostomy (in non-tracheostomized patients) and decannulation (in tracheostomized patients). Secondary outcomes included complications (granuloma, aspiration, bronchopneumonia, and laryngeal stenosis), need for reintervention, exercise tolerance (stair-climbing capacity), and patient-reported voice changes.
Results: Twenty-one (21) surgeries were performed on 19 patients at mean postoperative follow-up of 64 months. Although granuloma at the vocal fold level was observed in 5 of the 21 surgeries (23.80%), all of them recorded full resolution after introducing inhaled corticosteroids, and none of the cases presented granuloma formation or aspiration capable of making oral feeding impossible. Furthermore, no bronchopneumonia case was observed. The total of 11 patients in the whole cohort did not require tracheostomy prior to surgery.
Conclusion: Posterior endoscopic ventriculotomy combined with posterior transverse cordotomy provides full visualization of the lateral extent of the vocal fold, enabling a comprehensive cordotomy without arytenoid resection. The technique was safe, achieved high rates of tracheostomy avoidance/decannulation, and had acceptable complication and reintervention rates.
期刊介绍：
The Journal of Voice is widely regarded as the world''s premiere journal for voice medicine and research. This peer-reviewed publication is listed in Index Medicus and is indexed by the Institute for Scientific Information. The journal contains articles written by experts throughout the world on all topics in voice sciences, voice medicine and surgery, and speech-language pathologists'' management of voice-related problems. The journal includes clinical articles, clinical research, and laboratory research. Members of the Foundation receive the journal as a benefit of membership.
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