Outcome of Unilateral Transverse Cordotomy or Kashima Operation for Bilateral Vocal Cord Immobility.

Abstract

Endoscopic laser cordotomy, also known as Kashima operation, is used for the treatment of bilateral vocal cord palsy where the glottis chink is made posteriorly, sufficient enough for patient to breathe comfortably without any stridor. The objective of the study was to assess outcome of unilateral transverse cordotomy (Kashima operation) for bilateral vocal cord immobility. This prospective observational study was conducted in the Department of Otolaryngology-Head & Neck Surgery, Bangladesh Medical University, Dhaka, Bangladesh from January 2020 to June 2021 with 12 patients having bilateral vocal cord immobility with shortness of breath (SOB) or tracheostomized for SOB due to bilateral vocal cord immobility. The diagnosis was confirmed by fiberoptic laryngoscopy. Endoscopic assessment of subglottis and trachea was also done for assessment of any co-incidental pathology which may affect the outcome. Outcome of the surgery was evaluated by Flow volume loop Spirogram, Medical Research Council Dyspnoea Scale (MRCDS) 2007 and Voice Handicap Index (VHI) scores. All the information were recorded in a pretested questionnaire. The mean ±SD preoperative MRCDS was 4.33±0.49 and mean postoperative MRCDS was 1.75±1.06, 1.50±0.80 and 1.33±0.6 at 1st, 2nd and 3rd months of follow-up respectively. Mean ±SD preoperative total VHI score was 24.50±2.11 and postoperative score was 75.50±25.57, 44.17±31.50 and 37.33±22.86 at 1st, 2nd and 3rd months of follow-up respectively. MRCDS was significantly improved after Kashima operation (p<0.001). But no significant difference was observed in pre and at 3 months postoperative VHI score (p>0.05). In this study, preoperative mean of FVC, PEFR, PIFR, FEF50% and FIF50% were found 1.7±0.09 L, 2.5±0.12 L/S, 1.75±0.11 L/S, 0.84±0.06 and 2.08±0.38 respectively. Postoperative means of FVC, PEFR, PIFR, FEF 50% and FIF 50% were found 2.5±0.12 L, 4.5±0.12 L/S, 3.54±0.54 L/S, 1.84±0.40 and 3.54±0.69 at follow-up period of 2 months respectively. Statistically significant differences were observed in between pre and postoperative all the parameters of spirometry (p<0.001). In this study, only 2(16.67%) cases were developed complications after surgery. Vocal cord oedema in 1(8.33%) case and Fibrosis with granuloma in 1(8.33%) case. Kashima procedure is an effective surgery to reduce the severity of dyspnoea in bilateral vocal cord immobility without significant change of voice.