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Awake office based trans nasal flexible endoscopicdiode laser assisted posterior cordotomy for bilateral vocal fold paralysis


Journal of Otolaryngology-ENT Research
Phaniendrakumar V, Ramachandrareddy S, Ravindranath TA, Krishnamohan K

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Abstract

Purpose: The purpose of this retrospective study is to describe our experiencewith the new technique of Awake Office Based Flexible Endoscopic Diode Laser assisted Posterior Cordotomy for Bilateral Vocal Fold Paralysis. The technique was primarily designed as an alternative to traditional Micro suspension CO2 posterior cordotomy for patients of Bilateral Vocal Fold Paralysis when associated with co morbidity leading to either difficulty for suspension laryngoscopy or high risk for general anesthesia. Materials and methods: The study was carried out on 20 patients of Bilateral Vocal Fold Paralysis associated with co morbidity with limitations for Micro suspension cordotomy. 12 patients were females and 8 patients were males in the age group of 25 and 75 years, attending Sri Sathya Sai E.N.T Hospital and Research Center for Voice Disorders, India from January 2012 to January 2017. All the patients were operated by Posterior cordotomy done in office based setup under local anesthesia using Fiberoptic fiberoptic flexible laryngoscope and diode fiberlaser. Results: Results proved the efficacy of the procedure based on the Pre and postoperative pulmonary function tests and Voice Handicap Index scores which were statistically significant. Conclusion: The new technique was proved as safe and perfect alternative to traditional micro suspension cordotomy in patients of bilateral vocal fold paralysis associated with comorbities leading to either difficulty for suspension laryngoscopy or high risk for general anesthesia. The study also described it’s advantages such as conservation of voice by avoiding the over correction of glottic space by monitoring the voice intraoperatively and feasibility for revision cordotomy in the Office basis. 

Keywords

bilateral vocal fold paralysis, airway, diode laser, office based laryngeal surgery, voice, stridor, posterior cordotomy, awake surgeries

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