Long-Term Postoperative Swallowing Findings After Carbon Dioxide Laser Transverse Posterior Cordotomy in Bilateral Vocal Fold Paralysis: A Retrospective Cross-sectional FEES Study.

Abstract

Objective: To describe the frequency and pattern of long-term postoperative swallowing abnormalities detected by flexible endoscopic evaluation of swallowing (FEES) after carbon dioxide (CO₂) laser transverse posterior cordotomy for bilateral vocal fold paralysis (BVFP), and to relate these findings to patient-reported and functional swallowing measures.

Methods: This retrospective, single-center cross-sectional study included 17 adults with BVFP who had previously undergone CO₂ laser transverse posterior cordotomy and were evaluated at a single postoperative time point between January and June 2025. Swallowing safety and efficiency were assessed using FEES with boluses representing International Dysphagia Diet Standardisation Initiative levels 0 (thin liquid; dyed water), level 3 (moderately thick; dyed yogurt), and level 7 (regular; cracker). Airway invasion and pharyngeal residue were graded using the Penetration-Aspiration Scale and Yale Pharyngeal Residue Severity Rating Scale. Functional Oral Intake Scale (FOIS), Functional Outcome Swallowing Scale (FOSS), and Eating Assessment Tool-10 scores were also recorded.

Results: All participants were female (n=17; mean age 60.9±13.3 years) with a mean postoperative follow-up of 70.6±41.6 months. Penetration was common across consistencies; thin-liquid aspiration occurred in one patient. Vallecular and pyriform sinus residue was observed in a subset of patients. Most maintained full or near-full oral intake (FOIS 7, 76.5%) with mild functional limitation (FOSS 1-2, 94.1%).

Conclusion: This descriptive postoperative series contributes objective FEES-based long-term swallowing data after CO₂ laser transverse posterior cordotomy in BVFP. FEES frequently demonstrated penetration and pharyngeal residue despite generally preserved oral intake, but these findings should not be interpreted as a treatment effect because baseline swallowing data were unavailable.