Cordotomy by Coblation in Bilateral Vocal Fold Immobility

Abstract

Objective: 1) Understand the presentation, etiology, and management of bilateral vocal fold immobility. 2) Understand the utility, technique, and advantage of endoscopic coblation vocal cordotomy for patients with bilateral vocal fold immobility. 3) Compare the use of the laryngeal coblator with the laser.

Method: Case series using endoscopic coblation to perform vocal cordotomy in patients with bilateral vocal fold immobility is presented. Seven patients underwent suspension microlaryngoscopy with either initial or revision vocal cordotomy with or without partial arytenoidectomy. Routine follow-up was performed and wound healing was documented via distal chip videolaryngoscopy.

Results: Seven patients underwent suspension microlaryngoscopy with vocal cordotomy as part of airway management for bilateral vocal fold immobility. The laryngeal coblator was used to perform a transverse cordotomy. The procedure was completed in approximately 5 minutes. No laser protection is required reducing operative set-up and procedure time versus the laser. Two patients had a prior tracheotomy. No patients required a tracheotomy with this procedure. Patients were seen between 1 day and 1 month postoperatively. Patients had minimal granulation tissue at the cordotomy site and appeared to have quicker healing. The glottic airway and stridor were improved in all patients.

Conclusion: Initial outcomes of endoscopic coblation vocal cordotomy reveal this technique to be safe and efficient. Coblation increased the glottic airway with minimal granulation tissue and rapid healing. This represents the first described use of coblation for bilateral vocal fold immobility. Long-term data will be forthcoming.