Radiofrequency posterior cordotomy in bilateral vocal cord paralysis

Radiofrequency posterior cordotomy in bilateral vocal cord paralysis. Objective: To evaluate the efficacy of unilateral posterior cordotomy with radiofrequency in patients with bilateral abductor vocal cord paralysis using a novel method that utilized pixel counts to evaluate the rima glottidis opening of the glottic area postoperatively. Methodology: This retrospective study enrolled patients who underwent unilateral posterior cordotomy with radiofrequency upon the diagnosis of bilateral abductor vocal cord paralysis at our clinic between 2011 and 2016, and who attended regular follow-up visits. The preoperative videolaryngostroboscopic (VLS) images of the rima glottidis opening in patients were compared with the 2 month postoperative VLS images by calculating the pixel count in the rima area using the Scope View program. Results: Nine patients were included in the study (7 females, 2 males). Mean age was 54 (range: 34-72) years. Eight patients had a history of total thyroidectomy and the remaining patient had a history of irradiation due to larynx cancer. The most significant complaint of all the patients was respiratory distress. A tracheotomy was opened preoperatively in eight patients and postoperatively in one. Patients’ average duration of decannulation was 2.4 months. VLS images obtained at the 2-month postoperative visit revealed an increase of approximately 97% (23-167%) in the rima glottidis area opening (p<0.008). Conclusion: Unilateral posterior cordotomy with radiofrequency is a safe surgical method that ensures a sufficient rima glottidis opening and enables early decannulation; however, we believe that it should be preferentially used in patients with tracheotomy due to the edema that may occur during the early postoperative period.