The most common cause of bilateral vocal cord paralysis is thyroidectomy. If the injury is to the recurrent laryngeal nerve only, the paralysed vocal folds assume a position very close to that necessary for phonation, but the real problem is
airway
compromise. Sooner or later, all patients with bilateral abductor paralysis have stridor. This may be present immediately after operation or may be precipitated later by an upper respiratory tract infection, so a tracheotomy is required.
The form of therapy used to provide an adequate airway depends upon the patients individual needs and preference. There are those patients who will want to maintain a permanent tracheotomy, and a normal voice. There are others who will prefer
decannulation by widening of the airway. But, the greater the lateralization achieved, the grater the chance of aspiration and the greater the degree of hoarseness. Vocal fold lateralization can be classified as lateral fixation of cord,
arytenoidopexy,
arytenoidectomy, and cordectomy. Reinervation of paralysed posterior cricoarytenoid muscle is theoretically superior to other means of glottic airway because there is no further loss of voice, but remains controversal now.
In this study, we have had 4 cases of bilateral vocal fold paralysis with lateral fixation of the vocal fold, the results were all relatively satisfactory. The advantages claimed are that no perioperative tracheotomy is needed, the influence on
the
voice is adjustable, and if needed there remained the possibility of performing a more extensive surgical procedure. (Korean J Otolaryngol 38:12, 1995)
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