Surgical Treatment for Bilateral Vocal Fold Immobility

Abstract

Bilateral vocal fold immobility influences not only vocal function but also the airway tract, possibly resulting in dyspnea. Pathophysiological diagnosis using electromyography of laryngeal muscles is also critical for patients with bilateral vocal fold immobility to optimize the surgical procedures. Vocal fold lateralization, transverse cordotomy, and arytenoidectomy can be utilized for bilateral vocal fold paralysis and posterior glottic stenosis depending on the severity of stenosis and mobility of cricoarytenoid joints. A unilateral approach should be recommended for the initial surgery to reduce the risks of aspiration and hoarseness. Laryngofissure with cartilage grafting and T-tube stenting may be performed for severe posterior glottic stenosis, often coinciding with subglottic stenosis. Laryngeal stenosis due to the bilateral vocal fold immobility should be carefully evaluated and treated with appropriate surgical technique, thereby keeping adequate airway space with preventing severe postoperative swallowing and phonatory dysfunction.