Lateral fixation of the vocal cord instead of tracheotomy in acute bilateral vocal cord paralysis

摘要

BACKGROUND AND STATEMENT OF THE PROBLEM: The dyspnea resulting from an acute bilateral paralysis of the recurrent nerve often requires tracheotomy. Such a situation occurs most frequently after thyroid resection. It was analysed how the endo-extralaryngeal laterofixation of one vocal cord can contribute to avoid tracheotomy. PATIENTS AND METHODS: 40 patients (37 women, three men; mean age 42.9 years, range: 20-78 years, standard deviation: 9.2 years) with bilateral paralysis of the recurrent nerve after thyroid resection were treated by performing the technique mentioned below. The surgery was performed with an endo-extralaryngeal suture technique by Lichtenberger. Monofilament threads were looped around a vocal cord and transfixed through the skin. RESULTS: 39 of 40 patients described an immediate improvement of the breathing situation and thus tracheotomy could be avoided. With reinnervation of the vocal cords the sutures could be removed in 17 of 40 patients within the first 12 months. In the other 23 patients the reversible treatment was changed into a permanent posterior glottic dilatation via endoscopy. CONCLUSIONS: Laterofixation via endo-extralaryngeal suture technique improves the airway situation immediately in patients suffering from bilateral vocal cord paralysis due to benign or malignant thyroid surgery. Thus tracheostomy can be avoided. The advantage of the reversibility of this technique becomes evident by the fact that the threads can be removed with recovery of the function of the vocal cords. The limits of this method seem to be achieved when the vocal cord is previously damaged due to e.g. a long-term intubation which results in an increased vulnerability of the vocal cords. Thus they cannot sufficiently resist the suture material.