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Purpose: Bilateral vocal fold paralysis (BVFP) is a critical condition in newborns, which may present with significant airway distress necessitating tracheostomy. The purpose of this study is to report the safety and effectiveness of endoscopic percutaneous suture lateralization (EPSL) for newborns with BVFP, and evaluated the long‐term results and the stability of the lateralization. Methods: A review of patients undergoing EPSL for BVFP at our institutions was performed between October 2018 and June 2023. Preoperative and postoperative clinical information was collected. The functional outcomes of the surgery in terms of breathing, voice, and swallowing were evaluated and recorded. Results: Twenty seven patients were included, with a median age at diagnosis of 12 days (range, 1–33 days). The maximum follow‐up is for 5 years. EPSL was successful in 77.8% of cases, effectively avoiding the need for tracheostomy. Dyspnea was relieved within a month after surgery, enabling patients to tolerate oral feeds within 2 months after surgery. Notably, some patients experienced a return of vocal fold function, particularly in successful EPSL cases, underlining the procedure's efficacy. Minor complications, including granulation tissue and wound infection, were observed but were manageable. Major complications were notably absent. The results are durable and stable at long‐term follow‐up. Conclusion: EPSL for BVFP is a relatively simple, minimally invasive, non‐destructive, safe, and effective procedure in newborns, which may avoid the need for a tracheostomy, preserves the laryngeal framework, and does not affect the natural recovery of vocal cords. Level of Evidence: 3: retrospective case series Laryngoscope, 135:429–437, 2025 [ABSTRACT FROM AUTHOR]

Introduction: Type 4 posterior glottic stenosis and bilateral vocal fold paralysis are clinically challenging causes of bilateral vocal fold immobility (BVFI) that result in glottic airway obstruction. Established procedures for BVFI typically worsen dysphonia. We hypothesize the use of thyroarytenoid myomectomy (TAM) in the setting of BVFI will improve dyspnea with decreased detriment to voice. Methods: Eleven unilateral TAM procedures were performed between April 2021 and June 2023 at a single institution. Pre‐ and postoperative patient reported outcomes were compared. Representative images of maximal glottic opening were analyzed in ImageJ to calculate ipsilateral bowing index (BI), total BI, maximum glottic surface area (MGSA), and maximum opening angle (MOA). Statistical comparisons were performed with paired t‐tests when normality was confirmed with Shapiro–Wilk test and otherwise with Wilcoxon signed‐rank tests, with threshold for significance of α = 0.05. Interrater reliability for objective glottal measures was compared with intraclass correlation coefficient (ICC). Results: Dyspnea Index improved from mean (standard error) of 24.1 (3.8) to 9.1 (3.3), p = 0.004. Voice Handicap Index‐10 improved from 20.0 (4) to 10.3 (3.8), p = 0.011. Glottal Function Index improved from 9.6 (1.4) to 6.3 (1.3), p = 0.017. There was no significant difference in ipsilateral BI, total BI, MOA, and median MGSA. There was good to excellent ICCs for all comparisons (0.83–0.95). Conclusions: TAM demonstrated significant improvement in symptoms from BVFI while not significantly altering glottal structure. These data suggest TAM improves dyspnea in patients with BVFI without significantly impairing voice. Level of Evidence: 4 Laryngoscope, 134:4307–4312, 2024 [ABSTRACT FROM AUTHOR]

Background: Bilateral vocal cord palsy (BVCP) continues to be a challenge for laryngologists. The cause varies from idiopathic to trauma. At present, there are many static surgical treatments available for BVCP, which improve airway at the expense of voice. More than 75% of nerve fibers goes to adductors. Bilateral adductor involvement is rare in BVCP. For improving the airway without compromising the voice a dynamic procedure is needed. Two such procedures at experimental stages are total selective reinnervation and posterior crico arytenoid (PCA) pacemaker. Here, we are analyzing our experience with eight such cases of total selective reinnervation. Aim: To assess the efficacy of total selective reinnervation in cases of BVCP. Objectives: (1) To assess the improvement in airway post total selective reinnervation; (2) To assess the improvement in voice post total selective reinnervation; (3) To assess the involvement of swallowing function in total selective reinnervation. Methodology: This is a prospective study of 8 cases of BVCP who had undergone total selective reinnervation during a period of 9 years. Among the eight cases, two cases had idiopathic BVCP and six cases were post total thyroidectomy. All patients had a minimum follow-up period of 12 months except the last case which was in 7th postoperative month. Patient selection: all cases were seen within 2 years of their complaint except the child with congenital bilateral vocal cord palsy which was done at 4 years. Examination under anesthesia was done in all cases to rule out cricoarytenoid joint fixity. Electromyography (EMG) was not done. Pre-op assessment of quality of voice in each of these patients was done with Voice Handicap Index (VHI-10). Glottic space assessment was done with dyspnoea index score and flexible endoscopy. None of the patients had swallowing dysfunction at presentation. A repeat assessment was done at 6 and 12 months post-op and the results were compared. Results: In the immediate post-op period, all the patient had worsened voice quality. However, voice improved by 4 months and by 12 months all patients had better voice and lower VHI. Regarding airway: six patients were decannulated in 2 weeks, one patient was decannulated after 4 months and the youngest one after 1 year. By 6 months all patients had improved their dyspnea index by 1. However, between 8 and 12 months four patients had worsening dyspnea index requiring static procedures. Out of the four patients who did not require static procedures, one has completed only 6 months. The immediate swallowing dysfunction following the procedure improved within a period of 2 weeks. Conclusion: Total selective reinnervation improved the voice in all cases and it did not have any adverse effect on swallowing; however, the long-term effect in improving the airway was only in 50% of patients. The best results were obtained in younger patients. This is in sharp contrast with nonselective reinnervation for unilateral vocal cord palsy, whose success rate is as high as as 95%. This suggests that total selective reinnervation is to be taken up only in selected patients and that too only after detailed discussion about the final outcome and possible need for further surgical procedures. [ABSTRACT FROM AUTHOR]

Abstract Background The study was performed to evaluate the changing trends in etiology and presenting features of vocal cord paralysis (VCP) from March 1998 to March 2020. Methods Patient’s record collected from hospital database and divided into two groups, from March 1998 to March 2009 and from April 2009 to March 2020, to evaluate the changing trends in etiology and presenting features. Results Total of 711 VCP patients, 80.3% with unilateral (UVCP) and 19.7% with bilateral vocal cord paralysis (BVCP) included. The commonest etiology was non-surgical (57.1%) for UVCP and surgical (55.7%) for BVCP. The commonest surgical etiology was thyroid and parathyroid surgery for both UVCP (16.6%) and BVCP (38.5%). The commonest non-surgical etiology was idiopathic for UVCP (23.1%) and malignancies for BVCP (13.6%). There was increase in surgical etiology for both UVCP (39.3 to 45.3%) and BVCP (51.2 to 57.7%), and decrease in non-surgical etiology for both UVCP (60.7 to 54.6%) and BVCP (48.8 to 42.3%). The change in voice was most common presenting features for both UVCP (69.2%) and BVCP (92.8%). The frequency of the presenting features was comparable, with decrease in the duration of symptom onset over the time period. Conclusion The most common etiology for UVCP was idiopathic, and for BVCP was thyroid and parathyroid surgery. For both, UVCP and BVCP there was increasing trend for surgical and decreasing trend for non-surgical etiology. The change in voice was the most common presenting complain, with decrease in duration of symptom onset over time period.

Obstructive sleep apnoea (OSA) is typically caused by multilevel obstruction of the upper airway. Laryngeal obstruction from bilateral vocal cord paralysis (BVCP) is a rare cause of OSA. The predominance of nocturnal symptoms is likely due to decreased tone and activity of the laryngeal muscles during sleep, therefore reducing the glottic calibre and limiting airflow through the glottis.While BVCP is a rare cause of OSA, it is a well-recognized and significant complication of thyroid surgery due to the proximity of the recurrent laryngeal nerve to the thyroid gland. However, patients classically develop acute stridor in the immediate post-operative period, rather than a delayed presentation of “snoring”.In this article, we describe a series of two rare cases of non-obese patients with BVCP, presenting with “snoring” to the ENT Sleep Clinic, some months to years after their thyroid surgery. One patient decided on expectant management, the other underwent a tracheostomy with relief of her symptoms.This case series illustrates the importance of performing a flexible nasoendoscopy to evaluate the upper airway tract, especially the vocal cords, in a patient who has a history of thyroid surgery and/or thyroid pathology who presents to the Sleep Clinic with seemingly benign “snoring”.

This systematic review and meta-analysis evaluated the efficacy of various glottic widening procedures (GWPs) in avoiding tracheostomy in infants with bilateral vocal cord paralysis (BVCP). A systematic literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library from inception to July 2023, without any timeframe limitations. Studies reporting GWPs (Endoscopic anterior-posterior cricoid split, Botox injection, suture lateralization, and other procedures including laser posterior cordotomy/arytenoidectomy) in infants with BVCP were included. Meta-analysis was performed to assess tracheostomy avoidance and secondary outcomes including voice, swallowing, and resolution of airway symptoms. Thirteen studies with 100 patients were included. The mean age was 51.6 days. The etiology of BVCP was idiopathic (83 %), neurologic (10 %), and acquired (7 %). The GWP interventions were successful in 88 % of patients, with only 12 % requiring tracheostomy after surgery. The pooled proportion for avoiding tracheostomy was 0.88 (95 % CI 0.82–0.94) across interventions, with no significant differences between techniques. Among patients who avoided tracheostomy, 64 % had normal voice, 86 % tolerated oral feeding, 77 % had airway symptom resolution, and 70 % had recovery of vocal cord mobility. GWPs prevent a majority of infants with BVCP from undergoing tracheostomy, without permanent alterations to laryngeal function. All interventions were comparable in efficacy. Further research with larger sample sizes is warranted. [ABSTRACT FROM AUTHOR]

Introduction: Kashima operation, also known as endoscopic laser cordotomy is used for the treatment of bilateral abductor vocal cord palsy where the glottis chink is made posteriorly, sufficient enough for patient to breathe comfortably without any strider. Materials and Methods: This Clinical Trial Was Performed On 12 Patients[1] with Bilateral Abductor Vocal Cord Paralysis. All Patients Underwent Kashimas Procedure and Post-Operative Voice, Respiratory and Deglutition Function Were Evaluated. Results: 75% of patients were females and the mean age of patients was 40.9 ±9.13 years. In our patients, the most common etiology of bilateral vocal cord palsy was thyroid surgery (n=10, 83.33%).There was a significant improvement in breathing after surgery (P=0.001). After the procedure, 70% of patient had mild voice handicap score, and MPT was in normal range in 91.6% of cases. Conclusion: Kashimas procedure is a satisfactory surgical treatment for treating bilateral vocal cord palsy in regards to strider. No aspiration was seen in any of the patients post-surgery and voice outcome of these patients was also satisfactory.

Multiple myeloma is B-cell neoplastic disease occurring as a result of monoclonal expansion of plasma cells. This lymphoproliferative disease may involve bone marrow and extramedullary soft tissues. It has been treated successfully over the years with chemotherapy. Novel chemotherapeutic agents may result in devastating unknown complication. Herein, we would like to report a case of bilateral vocal cord palsy following Bortezumib in an elderly gentleman with multiple myeloma. [ABSTRACT FROM AUTHOR]

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Abstract Background Congenital bilateral vocal cord paralysis is a rare occurrence. Approximately half the cases are associated with a major comorbidity, usually neurological, neuromuscular or malformative. Case presentation In a male newborn, respiratory distress syndrome and stridor were observed immediately following birth. The cause was bilateral vocal cord paralysis in the adducted position. Neuroradiological investigation revealed a unilateral discontinuity between the upper pons and the right medulla oblongata. Hypoplasia of the right posterior hemiarches of C1-C2 and the right exo-occipital bone was observed, as was a small clivus. MR angiography showed the absence of the distal right vertebral artery, with hypoplasia and parietal irregularities of the proximal segments. Respiratory autonomy was not obtained despite endoscopic laser cordotomy, corticosteroid therapy and nasal continuous positive airway pressure. The infant died at the age of 4 weeks after treatment was limited to comfort care. Conclusions A medullary lesion is an exceptional cause of congenital bilateral vocal cord paralysis. The strictly unilateral neurological and vascular defect and the absence of associated intracranial or extracranial malformation make this clinical case unique and suggest a disruptive mechanism. This case also highlights the help provided by advanced neuroimaging techniques, i.e. fibre tracking using diffusion tensor imaging, in the decision-making process.

Introduction: Kashima operation, also known as endoscopic laser cordotomy is used for the treatment of bilateral abductor vocal cord palsy where the glottis chink is made posteriorly, sufficient enough for patient to breathe comfortably without any strider. Materials and Methods: This Clinical Trial Was Performed On 12 Patients2 with Bilateral Abductor Vocal Cord Paralysis. All Patients Underwent Kashimas Procedure and Post-Operative Voice, Respiratory and Deglutition Function Were Evaluated. Results: 75% of patients were females and the mean age of patients was 40.9 ±9.13 years. In our patients, the most common etiology of bilateral vocal cord palsy was thyroid surgery (n=10, 83.33%).There was a significant improvement in breathing after surgery (P=0.001). After the procedure, 70% of patient had mild voice handicap score, and MPT was in normal range in 91.6% of cases. Conclusion: Kashimas procedure is a satisfactory surgical treatment for treating bilateral vocal cord palsy in regards to strider. No aspiration was seen in any of the patients post-surgery and voice outcome of these patients was also satisfactory. [ABSTRACT FROM AUTHOR]

Introduction: The presentation, course, and management of a rare laryngeal manifestation of neurosarcoidosis due to central nervous system (as opposed to peripheral nervous system) injury are described. Methods: The authors present 3 cases of vocal cord paralysis as the initial symptom of isolated neurosarcoidosis at a tertiary care laryngology clinic. Results: Laryngoscopy diagnosed unilateral vocal cord paralysis. Laryngeal electromyography revealed high vagal injury, prompting workup on brain magnetic resonance imaging. On magnetic resonance imaging, 2 cases showed basilar leptomeningeal inflammation and 1 case showed a brainstem mass. Patients were found at follow-up to have severe, progressive vagal injury, with patients developing severe quality of life impairments and medical complications. Conclusions: Neurosarcoidosis is not usually considered in the differential diagnosis of vocal cord paralysis. At initial presentation, all patients lacked other cranial neuropathies and systemic sarcoidosis manifestations, making diagnosis difficult. Otolaryngologists should be aware of this rare presentation, as prompt diagnosis by brain magnetic resonance imaging with or without central nervous system biopsy, as opposed to traditional chest radiography or computed tomography for the workup of peripheral nerve injury, is necessary. Serial laryngeal examinations are recommended for close monitoring of progressive disease and recommending treatment. Injection or medialization laryngoplasty can provide improvements in voicing but not swallow. [ABSTRACT FROM AUTHOR]

The article discusses a study focusing on the use of botulinum toxin in managing laryngeal synkinesis, a movement disorder, in patients with unilateral and bilateral vocal fold paralysis. Topics discussed include the treatments for dyspnea and stridor caused by laryngeal synkinesis, the use of laryngeal electromyography (LEMG) in the study, and the lack of effectiveness of botulinum toxin therapy.

Introduction Bilateral vocal cord paralysis in adducted position (BVCPAd) is a severe cause of airway obstruction and usually debuts with stridor and airway distress necessitating immediate intervention. Tracheostomy has long been the gold standard for treating this condition, but has significant associated morbidity and mortality in pediatric patients. New conservative procedures have emerged to treat this condition thus avoiding tracheostomy, like endoscopic anterior and posterior cricoid split (EAPCS). The objective of this paper was to review our experience with EAPCS in newborns and infants. Methods Prospective study involving patients undergoing endoscopic EAPCS for symptomatic BVCPAd. The primary outcomes were tracheostomy avoidance and resolution of airway symptoms. Results Three patients underwent EAPCS between January 2016 and December 2016. All patients stayed at least 7 days in the Intensive Care Unit (ICU) intubated. All patients presented complete resolution of their symptoms due to airway obstruction, without the need for tracheostomy. Conclusion EAPCS is a novel and effective alternative to treat BVCPAd in patients under 1 year old. Our study is an initial experience; more cases are required to identify the real impact and benefits of this technique and to determine the proper selection of patients. [ABSTRACT FROM AUTHOR]

We describe a patient with acute respiratory insufficiency and difficult ventilator weaning in the ICU ward, leading to diagnosis of small cell lung cancer with superior vena cava superior syndrome. Bilateral vocal cord paralysis caused his respiratory distress and weaning difficulties. Thyroidectomy and neurological problems (such as Parkinson disease and Guillain Barré syndrome) are more common causes of bilateral vocal cord paralysis. Lung cancer patients are also at risk due to mediastinal invasion. The left recurrent laryngeal nerve is more prone to paralysis because of the typical anatomy. In contrary, bilateral vocal cord paralysis is rare and doesn't result in speech problems but rather breathing difficulties. Tracheostomy is the classic therapy, but laser cordectomy and Botulinum toxin injection in the laryngeal muscles are alternatives.

Conclusion: This method is an easy, non-expensive, and effective technique in bilateral vocal cord paralysis to improve glottic airway and clinical performance. Objective: To evaluate the effectiveness of 'suture arytenoid laterofixation' surgery in bilateral vocal cord paralysis. Materials and methods: A retrospective analysis of patients' medical history undergoing 'suture arytenoid laterofixation' surgery for bilateral vocal cord paralysis. This technique was applied under general anesthesia with both microlaryngoscopy and video-monitoring. Two 16 g needles and one 1/0 nylon thread were used for the procedure with 1 cm skin incision; no tracheotomy or tissue excision was required. Pre-post-operative photographs of the glottic region were taken from the endoscopic records, and the areas of rima glottis openings were calculated with the Image-J programme. Results: Forty-seven patients were analyzed. The mean pre-post-operative rima glottis areas were 1.11 ± 0.56 and 2.24 ± 0.93 mm2, respectively ( p < 0.001). Five patients with previous tracheotomy were decannulated within a few days after the operation. In three patients, mild complications developed in the early post-operative period (two laryngeal edemas, one submucosal hematoma). Tracheotomy was performed to only one pregnant patient in the post-operative first day. None of the patients had granulation formation or synechia. [ABSTRACT FROM AUTHOR]

To compare the functional results between posterior cordotomy, cordoplasty and external procedure in managing bilateral vocal cord paralysis in one of the largest published study group. Retrospective and comparative study. 54 patients with bilateral vocal cord paralysis who underwent posterior cordotomy (Group-I), cordoplasty (Group-II) and external procedure (Group-III) from 2001 to 2013 were compared for functional outcomes. Successful decannulation was achieved more in Group-I and II than in Group-III. Voice outcome was better in Group-II patients compared to other groups. Outcomes of cordoplasty was better than posterior cordotomy and external procedures, with acceptable airway and good quality of voice. Posterior cordotomy is preferred in patients without tracheostomy and in pediatric patients. In patients with tracheostomy or who accept temporary tracheostomy, a cordoplasty is preferred for favorable voice. External procedure is preferred for patients not fit for general anesthesia. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To evaluate the clinical value of polysomnography in patients with a tracheotomy due to chronic upper airway obstruction prior to attempting decannulation. Study Design Retrospective chart review. Methods Subjects with chronic upper airway obstruction were identified using a clinical database between 2000 and 2014. All subjects had a tracheotomy, were assessed by the senior author in a tertiary care academic center, and underwent polysomnography prior to attempting decannulation. Patients were excluded if they did not undergo polysomnography or had severe obstructive sleep apnea as the primary indication for tracheotomy. Results Fifteen patients were identified. The majority (87.5%) of patients were successfully decannulated after their first polysomnography showed acceptable results when carried out with the tracheotomy occluded. Obstructive sleep apnea was identified in four of the nine patients who tolerated overnight tracheotomy occlusion, and continuous positive airway pressure (CPAP) was initiated. An additional four of the remaining six patients were decannulated after subsequent polysomnography demonstrated improvement with CPAP, and two required an additional airway procedure. Conclusions Chronic upper airway obstruction requiring tracheotomy can be challenging to treat and successfully decannulate. Indirect laryngoscopy is essential to evaluate the anatomy of the larynx; however, it cannot assess potential increased obstruction during sleep. The study indicates that polysomnography can assist with the evaluation of decannulation readiness in patients with chronic upper airway obstruction as an adjunct measure in addition to imaging and laryngoscopy. Level of Evidence 4 Laryngoscope, 124:2574-2578, 2014 [ABSTRACT FROM AUTHOR]

Vocal cord paralysis is one of the most serious anesthetic complications related to endotracheal intubation. The practitioner should take extreme care, as bilateral vocal cord paralysis can obstruct the airway and lead to disastrous respiratory problems. There have been many papers on bilateral vocal cord paralysis after neck surgery, but reports on such a condition after lung surgery are very rare. We report a case of bilateral vocal cord paralysis detected after removal of a double-lumen endotracheal tube in a 67-year-old patient who underwent wedge resection by video-assisted thoracoscopic surgery. We also note that he recovered spontaneously without complications within a day.

Abstract: Objective: Bilateral vocal cord abductor paralysis (BVCAbP) is considered a rare cause of stridor in the newborn. The goal of this work is to present a case series and to review systematically the literature on bilateral vocal cord abductor paralysis in the newborn to better characterize the current knowledge on this entity. Methods: We performed a systematic literature review with Medline (1950–2011). The authors screened all cases of BVCAbP reported and selected those affecting newborns. Results: Out of the 129 articles screened, 16 were included. A total of 69 cases could be retrieved and analyzed. Associated co-morbidities were found in 54% of the patients, most notably malformative conditions (intracranial or other), or a positive perinatal history (trauma/asphyxia, prematurity). Tracheostomy placement was required in 59% of children, and of these 44% were successfully decannulated. In terms of functional outcome full recovery or improvement were seen in 61% of patients. Major underlying co-morbidities affected negatively the functional outcome (p =.004), but not the need for tracheostomy (p =.604) or the decannulation success rate (p =.063). Conclusion: BVCAbP in the newborn is a serious cause of airway obstruction. It can be seen either in a context of multisystem anomalies or as an isolated finding. Newborns with major co-morbidities affecting their normal development are more likely to have poor functional outcomes and to remain tracheostomy-dependant. [Copyright &y& Elsevier]

Background: Vocal cord paralysis is a rare cause of obstructive sleep apnea syndrome (OSAS). Recurrent laryngeal nerve injury after thyroid gland surgery is one of the leading causes of acquired vocal cord paralysis. Report: A 46-year-old woman with OSAS due to bilateral abductor vocal cord paralysis was presented. She had thyroidectomy 30 years ago and had a weak, breathy voice. She had been referred with a history of high-pitched snoring, apnea witnessed by her spouse, and excessive daytime sleepiness for the last 5 years. Full-night polysomnography revealed that her apnea-hypopnea index was 72/h and minimal oxygen saturation level was 81%. There was no REM and deep sleep periods. Ear-nose-throat consultation offered an endoscopic bilateral posterior cordotomy operation via microscopic suspension laryngoscopy (MLS) as a treatment option. Conclusions: Instead of using a nasal positive airway pressure (nCPAP) device, she was treated surgically. Her OSAS resolved completely within 5 months of the surgery. Her phonation was preserved, and symptoms such as snoring and hypersomnolance disappeared. In OSAS patients with bilateral vocal cord paralysis, MLS-associated bilateral posterior cordotomy can be a choice of treatment as an alternative to nCPAP application. [ABSTRACT FROM AUTHOR]

Introduction: Different techniques are used to reduce laryngeal obstruction in bilateral vocal cord paralysis. Methods: This article describes one of the simplest and less traumatic techniques that can be used in cases of bilateral vocal cord paralysis. This technique has been previously published, but it is the first time to be used in Malta. No preoperative tracheostomy is needed. This procedure is carried out under general anesthesia where two needles are inserted through the thyroid cartilage. Non-resorbable monofilament sutures are introduced through the needles and the needles are then withdrawn. The fiber thus forms a permanent loop around the vocal cord. Conclusion: Using this new method the patients' breathing as well as voice quality improves significantly. Apart from being very effective, this technique is also minimally invasive and at the same time doesn't preclude more extensive surgical procedures from being performed. [ABSTRACT FROM AUTHOR]

Bilateral vocal cord paralysis may occur as a result of mechanical injury during neck surgery, nerve compression by endotracheal intubation or mass, trauma, and neuromuscular diseases. However, only a few cases of bilateral vocal cord paralysis have occurred following short-term endotracheal intubation. We report a case of bilateral vocal cord paralysis subsequent to extubation after endotracheal intubation and mechanical ventilation due to severe pneumonia for 2 days. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Selective reinnervation of the posterior cricoarytenoid muscle with a single phrenic nerve rootlet has been shown to restore physiologic motion in animal models. However, clinical translation of this work is challenged by the limited knowledge of the cervical anatomy of the phrenic nerve. Study Design: Prospective collaborative study. Methods: Dissection of 111 cadaveric necks (88 embalmed and 23 unembalmed) from 56 cadavers. Results: The mean (standard deviation) lengths of unembalmed cadaver C3, C4, and C5 nerve rootlets were 3.9 (2.4), 3.6 (2.6), and 0.5 (0.8) cm, respectively. Embalmed cadavers had shorter C3 and C4 phrenic nerve rootlet lengths than unembalmed cadavers ( P = .02 and P = .03, respectively). There was no difference in mean nerve rootlet length based on sex, body height or weight, or side of dissection. A total of eight unique phrenic nerve rootlet patterns were identified. The most common pattern consisted of phrenic with single C3 and C4 rootlets with an immeasurable C5 rootlet, which was present in 30 of 111 (26%) of the necks. The classic three branching pattern of single C3, C4, and C5 rootlets was found in 25 of 111 (22%) of the necks. Six of 111 (5%) of the dissections displayed accessory phrenic nerves arising from the C3, C4, or C5 anterior rami. A χ2 analysis showed no difference between side or sex and frequency of pattern. Conclusions: The present study demonstrates the wide variability within the cervical anatomy of the phrenic nerve. [ABSTRACT FROM AUTHOR]

Objectives: (1) To present a rare case of stridor secondary to prolonged laryngospasm in a patient with Parkinson's disease, and (2) to review the literature on stridor in Parkinson's disease. Methods: We report a 73-year-old Parkinson's disease patient who developed acute stridor due to prolonged laryngospasm triggered by overspill of excessive secretions. The literature was reviewed, following a Medline search using the keywords 'Parkinson's disease' and 'stridor' or 'airway obstruction' or 'laryngospasm' or 'laryngeal dystonia' or 'bilateral vocal cord palsy'. Result: Only 12 previously reported cases of stridor in Parkinson's disease patients were identified. Causes included bilateral vocal fold palsy (eight cases), laryngospasm (five), and dystonia of the jaw and neck muscles (two). The mechanism of laryngospasm in our patient was similar to 'dry drowning', and has not previously been described. Conclusion: Laryngospasm can be triggered in Parkinson's disease by excessive secretions entering the larynx. The mechanism is similar to 'dry drowning'. Treatment focuses on reducing secretions. The use of botulinum toxin to reduce spasm is inappropriate in this situation. This case emphasises the importance of recognising different causes of stridor in Parkinson's disease patients, as this affects management. [ABSTRACT FROM AUTHOR]

For managing dyspnea caused by bilateral vocal cord paralysis as a complication of thyroidectomy in the acute postoperative period, reversible vocal cord lateralisation is performed at the authors’ departments. However, in the later postoperative period of thyroidectomy when there is no chance for recovery of the recurrent laryngeal nerves, they perform irreversible procedure. Applying these operative techniques satisfactory breathing can be achieved in about 95% of cases avoiding tracheostomy. In 5% of cases there are other comorbidities in the background of unsuccessful operative results which can cause potential dyspnea as well. From these complications the authors emphasize the role of laryngeal obstruction and myxedema as a consequence of hypothyroidism developed after thyroidectomy. Management of severe dyspnea caused by association of these two complications of thyroidectomy means a great therapeutic challenge. Between 01 Jan 1989 and 30 Nov 2008 the authors performed 161 reversible and 135 irreversible vocal cord lateralisations to manage dyspnea caused by bilateral vocal cord paralysis as a complication of thyroidectomy. From these cases four patients had further obstruction due to laryngeal myxedema. By performing endoscopic laryngeal surgeries and applying levothyroxine replacement therapy sufficiently wide glottic chink has been achieved in all the cases. According to the experience of the authors dyspnea caused by bilateral vocal cord paralysis after thyroidectomy needs complex, interdisciplinary therapeutic approach beside glottis widening operations. [ABSTRACT FROM AUTHOR]

The second most common cause of stridor reported in the newborn is bilateral vocal cord paralysis (BVCP) and one-third of the cases have been categorized as idiopathic. During the last year four children with stridor since birth were referred to our department for examination. Videotaped flexible laryngoscopy, carried out with the patient awake or under general anaesthesia with a spontanous respiration, revealed instead of abduction of the vocal cords during inspiration, rather an active adductory movement. Consequently instead of BVCP, we made the diagnosis paradoxical vocal cord movement (PVCM). One of the twins required a tracheostomy, the three other patients have been observed without the need of further treatment. No previous publications have described PVCM in newborn. However, our observations and video recordings clearly show that the stridor in our four patients is due to PVCM. This is possibly the same condition as earlier reported as congenital, idiopathic BVCP where incoordinated vocal cord movement or dyskinesia has been a part of the laryngoscopic findings. The mechanism behind PVCM in this age group or site of lesion is unclear. [ABSTRACT FROM AUTHOR]

Bilateral vocal cord paralysis is a symptom that may lead to serious breathing problems. The treatment of patients with vocal cord paralysis presents a challenge to otolaryngologists. Many techniques have been developed in an attempt to improve the patient's airway insufficiency. The aim of the study was to evaluate the efficacy of the laser total unilateral arytenoidectomy with posterior cordectomy in patients with bilateral vocal cord paralysis. Thrity-six patients (33 females, 3 male) aged between 24 and 76 (mean 52) were treated by laser arytenoidectomy. The flow-volume loop and pletysmography were performed in all patients before and after the operation. Additionally, a group of 15 patients with unilateral vocal cord paralysis was introduced and analyzed as a special control. Based on the relative increase of the parameters after the surgery, the most useful of them were selected for the evaluation. Also, the character of the laryngeal obstruction was defined. Changes in the flow-volume loop before and after surgery were compared by planned comparison in univariate analysis ANOVA/MANOVA with an isolated control group. As the parameters AREAEX, FEF50, FEF75, PEF and MMEF75/25 increased most effectively, they appeared to be the most useful in the evaluation. FIV1/FEF1, FEF50/FIF50 and FEV1/FEV0,5 allowed the definition of the obstruction as an extrathoracic dynamically variable quantity. The resistances measured during pletysmography diminished significantly after surgery. The introduction of the special control group with unilateral vocal cord paralysis showed that despite the significant improvement after surgery, the patients who had been operated on still had a laryngeal obstruction worse than that of patients from the control group. The laser arytenoidectomy is shown to be a useful and efficacious procedure for bilateral vocal cord paralysis. [ABSTRACT FROM AUTHOR]

We describe a patient with acute respiratory insufficiency and difficult ventilator weaning in the ICU ward, leading to diagnosis of small cell lung cancer with superior vena cava superior syndrome. Bilateral vocal cord paralysis caused his respiratory distress and weaning difficulties. Thyroidectomy and neurological problems (such as Parkinson disease and Guillain Barré syndrome) are more common causes of bilateral vocal cord paralysis. Lung cancer patients are also at risk due to mediastinal invasion. The left recurrent laryngeal nerve is more prone to paralysis because of the typical anatomy. In contrary, bilateral vocal cord paralysis is rare and doesn't result in speech problems but rather breathing difficulties. Tracheostomy is the classic therapy, but laser cordectomy and Botulinum toxin injection in the laryngeal muscles are alternatives. [ABSTRACT FROM AUTHOR]

Abstract: Bilateral vocal fold paralysis is a rare condition. The commonest cause identified is mostly iatrogenic. It can be extremely debilitating for the patient who usually suffers from severe breathlessness on slightest exertion. Many of them requires a tracheostomy to maintain airway. The treatment of bilateral vocal cord palsy is a balance between phonation, airway and swallowing. Several surgical modalities have been described for cases which doesn't improve with conservative management. However transoral CO2 laser endoscopic arytenoidectomy has become the standard of management today for this condition. CO2 laser is arguably the most appropriate tool for cordectomy with the advantage of increased precision, better hemostasis and minimal tissue handling. We describe the procedure of posterior cordectomy with partial arytenoidectomy using transoral CO2 laser in two patients who were successfully managed for this condition in our centre. [Copyright &y& Elsevier]