Is Arytenoidectomy Necessary? A Comparative Study of Posterior Cordectomy Techniques in Bilateral Vocal Fold Paralysis.

Objectives: To compare decannulation rates and surgical outcomes between posterior cordectomy (PC) and posterior cordectomy with partial arytenoidectomy (PC+A) in bilateral vocal fold paralysis (BVFP).

Study design: Retrospective, observational.

Materials and methods: Patients diagnosed with BVFP who underwent either PC or posterior PC+A at a tertiary care center between 2012 and 2023. Surgical outcomes were analyzed, including decannulation rates, surgery duration, complications, and the need for revision surgery.

Results: Twenty-three patients were included, with the primary etiology being nerve injury following thyroid surgery. Most patients required preoperative tracheostomy. Both surgical techniques achieved comparable decannulation rates (87% PC vs 86% PC+A, P > 0.05). PC showed an advantage over PC + A regarding shorter operative time. No differences were observed in voice quality, swallowing function, complications. Revision rates were 31% for PC vs 0% for PC+A (P = 0.3).

Conclusion: Both PC and PC+A are effective surgical techniques for managing bilateral vocal fold paralysis, achieving comparable decannulation rates without significant compromise of voice or swallowing function. PC's shorter operative time may favor its use in select patients, while PC+A's lower revision rate warrants further study. These findings highlight the need for individualized approaches to treatment.