Posterior cordectomy and subtotal arytenoidectomy for the treatment of bilateral vocal fold immobility: Functional results

      This paper is only available as a PDF. To read, Please Download here.


      We report vocal and respiratory results following endoscopic CO2 laser therapy for bilateral vocal fold immobility in adduction. Two techniques were used: posterior cordectomy (PC) and subtotal arytenoidectomy (SA). Respiratory improvement was demonstrated by the peak expiratory flow/peak inspiratory flow ratio (PEF/PIF, normal = 1), which was less than 2 for 83% of patients following PC and for 81% following SA. As for vocal results, there were no significant quantitative differences between the two techniques. Mean maximum phonation time (/a/) was 6.8 ± 2.6 s after SA and 7.8 ± 1.6 s following PC. The phonation quotient was 288 ± 116 ml/s after SA and 304 ± 92 ml/s after PC. Mean vocal intensity was 62 ± 4 dB after SA and 59 ± 3 dB after PC. Vocal quality was measured by high-resolution vocal frequency analysis, as represented by a histogram. Peaks corresponding to fundamental frequency and first harmonics were preserved in more than 60% of patients in the two groups. Vocal preservation is better when the paralyzed folds are in the paramedian position, with the possibility of adduction (Gerhardt syndrome). SA is performed in our procedure, though it is longer and more difficult to perform than PC. PC often requires two procedures to achieve satisfactory results.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Peynegre R
        • Lelievre G
        Paralysies laryngées.
        Encyclopédie médico-chirurgicale. 1989; (Edition Technique): 1-17
        • King BT
        A new and function restoring operation for bilateral abductor cord paralysis.
        JAMA. 1939; 112: 814-823
        • Thornell WC
        Intralaryngeal approach for arytenoidectomy in bilateral abductor vocal cord paralysis.
        Arch Otolaryngol. 1948; 47: 505-508
        • Ossoff RH
        • Duncavage SA
        • Krespi Y
        • Shapshay S
        • Sisson GA
        Endoscopic laser arytenoidectomy revisited.
        Ann Otol Rhinol Laryngol. 1990; 99: 764-771
        • Crumley RL
        Endoscopic laser medical arytenoidectomy for airway management in bilateral laryngeal paralysis.
        Ann Otol Rhinol Laryngol. 1993; 102: 81-84
        • Ossoff RH
        • Karlan MS
        • Sisson GA
        Endoscopic laser arytenoidectomy.
        Laser Surg Med. 1983; 2: 293-299
        • Remacle M
        • Lawson G
        • Mayne A
        • Jamart J
        Subtotal CO2 laser arytenoidectomy by endoscopic approach for treatment of bilateral cord immobility in adduction.
        Ann Otol Rhinol Laryngol. 1994; (submitted)
        • Dennis DP
        • Kashima H
        Carbon dioxide laser posterior cordectomy for treatment of bilateral vocal cord paralysis.
        Ann Otol Rhinol Laryngol. 1989; 98: 930-934
        • Dejonckhere PH
        Techniques de base d'évaluation de la voix.
        in: Louvain-la-Neuve, 1985: 245-275
        • Remacle M
        • Millet B
        • Van Heule P
        • Duvivier P
        Clinical application of the high resolution frequence analyzer.
        Folia Phoniatr. 1989; 41: 259-269
        • Remacle M
        • Millet B
        • Van Heule P
        Application de l'analyseur de fréquence à haute résolution en pathologie de la corde vocale.
        Rev Offic S Fr ORL. 1990; 6: 15-24