Summary
Purpose
Endoscopic partial arytenoidectomy (EPA) is one of the static operations for treatment
of bilateral vocal fold paralysis (BVFP). Improvement in airway may cause voice loss
and aspiration. The author reports his experience on EPA using medially based mucosal
flap to enlarge posterior glottis without removing any part of membranous vocal fold.
Materials and Methods
Sixty-four consecutive patients with BVFP underwent EPA. Pre- and postoperative evaluations
included Voice Handicap Index-30, aerodynamic and acoustic analysis, flow volume loops,
perceptual evaluation of pre- and postoperative voice using grade, roughness, breathiness,
asthenia, strain (GRBAS) scale, speech intensity, breathing ability evaluation, and
functional outcome swallowing scale.
Results
Nine patients had preoperative tracheotomy and one patient required postoperative
tracheotomy. All tracheotomized patients were decannulated 1 month after surgery.
Fifty-six patients (88%) did not report dyspnea in their daily activities and were
considered satisfied with their postoperative airway; eight patients required revision:
seven total arytenoidectomy and one posterior cricoid split with costal cartilage
grafting. All Voice Handicap Index-30 results and all acoustic results (except fundamental
frequency) increased significantly after surgery (P < 0.05). All aerodynamic analysis results (except mean airflow rate) decreased significantly
after EPA (P < 0.05). Mean airflow rate increased significantly after EPA (P < 0.05). All flow volume loop parameters increased significantly after EPA (P < 0.05). Perceptual comparison of pre- and postoperative voice revealed similar grade
and roughness (P > 0.05); however, increased breathiness (P < 0.05) was observed. Mean speech intensity decreased from 67 dB to 61 dB (P < 0.05). Postoperative breathing ability was significantly better. Pre- and postoperative
functional outcome swallowing scales were not significantly different (P > 0.05).
Conclusions
EPA is a very successful static surgical option for BVFP. It results in comfortable
airway with mild voice handicap. Postoperatively, it does not increase aspiration
significantly. Endoscopic total arytenoidectomy is reserved for revision of failures.
Key Words
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Article info
Publication history
Published online: May 10, 2018
Accepted:
April 11,
2018
Footnotes
Conflict of interest: The author owns the patent for the laryngoscope for posterior laryngeal procedures.
Disclosure: This study was financially supported by Hacettepe University Research Fund (14964).
Identification
Copyright
© 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
