(0828) Posterior Cordectomy Versus Posterior Cordectomy and Arytenoidectomy in the Treatment of Bilateral Vocal Fold Paralysis

Introduction: To compare the surgical outcomes between posterior cordectomy and posterior cordectomy and arytenoidectomy in patients with bilateral vocal fold paralysis in terms of decannulation and avoidance of tracheostomy.

Methods: A retrospective, observational, and analytical study of patients with bilateral vocal fold paralysis who underwent posterior cordectomy or posterior cordectomy and arytenoidectomy in a tertiary care center in Mexico City was conducted. The study was performed between 2012 and 2023. In total, 64 patients were examined and 23 met the inclusion criteria. The analysis was made with Fisher's exact test and Wilcoxon rank sum test.

Results: Of the 23 patients, 13 were women (56.5%) and 10 were men (43.5%). The main etiology of bilateral chordal paralysis was iatrogenic injury due to thyroid surgery in 13 patients (56.5%). In our study, the mean age of patients with standard deviation was 51.57 +/- 14.75 with a median of 54 years. Posterior cordectomy was performed in 16 patients (69.6%), and posterior cordectomy and arytenoidectomy was performed in 7 patients (30.4%). In our study, laser was used in 19 patients (82.6%) and cold technique in 4 patients (17.4%). Regarding laterality, 11 (47.8%) were on the right side and 12 (52.2%) on the left side. No patient had a tracheostomy prior to the intervention and a prior tracheostomy was performed in 22 patients (95.7%) according to the surgeon's preference. Additionally, 16 (69.4%) patients underwent posterior cordectomy and 7 (39.4%) underwent posterior cordectomy and arytenoidectomy. Of the total, 13 patients (87%) who underwent posterior cordectomy and 6 (86%) who underwent posterior cordectomy and arytenoidectomy were decannulated. Of patients who underwent posterior cordectomy, 5 required revision surgery. There were no statistically significant differences when comparing both techniques (p > 0.05).

Conclusions: Both posterior cordectomy and posterior cordectomy and arytenoidectomy are effective as a surgical treatment of bilateral vocal fold paralysis. Both techniques allowed decannulation in most patients, without significant voice impairment or dysphagia.