Phonosurgical treatment of bilateral laryngeal paralyses

Bilateral vocal fold paralysis (BVFP) is a challenging clinical condition. The purpose of this study is to analyze the efficacy of a mini invasive permanent laterofixation of one vocal fold in widening the glottic respiratory space sparing the phonatory and sphincteric functions of the larynx. A mini-invasive modification of the permanent Lichtenberger laterofixation technique was performed to treat bilateral laryngeal immobility in 16 adult patients. Most patients had post-thyroidectomy BVFP (PT- BVFP); 1 had also posterior glottic scarring (PGS) blocking the cricoarythenoid joints, and 1 had Guillain-Barré syndrome. The patients were followed up with videolaryngostroboscopy, Maximal Phonation Time (MPT) measurement, Voice Handicap Index (VHI) questionnaire, and GRBAS perceptual evaluation Airway patency was restored in all patients with PT-BVFP. No postoperative dysphagia or severe dysphonia occurred in any patient. The voice quality of the patients remained stable or improved after surgery in all except 2 cases, presenting moderate breathiness, and long-term stability was confirmed by MPT, GRBAS, and VHI (p ranging between 0.004 and < 0.001). The technique proved to be successful in restoring airway patency for BVFP secondary to peripheral lesion of the recurrent laryngeal nerves and allowed to spare the laryngeal phonatory and sphincteric functions.