Vocal cordotomy or carbon dioxide laser endoscopic posterior cordotomy is a popular minimally invasive procedure performed to treat bilateral vocal fold (cord) paralysis. It is a laser-assisted incision of one or both vocal cords to widen the airway.
Vocal cordotomy is often preferred over a more invasive procedure called arytenoidectomy (partial removal of the arytenoid cartilage to widen the airway) due to reasons stated below:
- Improved breathing due to airway widening
- Elimination of the need for tracheostomy (a surgical opening made in the front of the neck and into the trachea)
- Maintenance of good vocal quality
- Preservation of the ability to swallow
- Technique with lower aspiration rates
Vocal cordotomy is not useful if only one vocal cord is paralyzed.
What is a vocal cord in humans?
Vocal folds or vocal cords are chord-like structures located within the larynx in the throat. They are open during inhalation to let the air in and come together (align together) during swallowing (to avoid water or food particles ending up in airways).
Production of speech is a major function of the vocal cords. The approximated (aligned) vocal cords vibrate during phonation (sound generation when you talk) and modulate the flow of expired air. It is this vibration that produces your sound and pitch.
When vocal cords are injured or paralyzed, it can cause hoarseness of voice, aspiration problems, and even loss of voice. Symptoms and their intensity often depend on whether vocal cord paralysis is unilateral or bilateral.
5 causes of vocal cord paralysis
Five causes of vocal cord paralysis include:
- Infections: Certain infections such as COVID-19, herpes, Lyme disease, and Epstein-Barr virus can cause inflammation and directly damage the nerves in the larynx.
- Inadvertent injury during surgery: A thyroid surgery or an interventional procedure on or near your neck such as endotracheal intubation can damage the laryngeal nerve that supplies your larynx.
- Neck or chest injury: Road traffic accidents or neck trauma may injure the laryngeal nerve or vocal cords.
- Neurological conditions: Stroke, multiple sclerosis, myasthenia gravis, or Parkinson's disease may result in vocal cord paralysis.
- Tumors: Cancerous and benign tumors of the neck and larynx can cause vocal cord paralysis.
5 potential complications of vocal cordotomy
Five potential complications of vocal cordotomy include:
- Vocal cordotomy is done under general anesthesia, and general complications include circulatory and respiratory disorders resulting from anesthesia
- Local injuries to the teeth, lips, and palate caused by the pressure of the laryngoscope on the base of the tongue or oropharynx
- Bleeding from the larynx during or after the operation
- Severe postoperative vocal cord edema
- Granuloma scars and adhesions post the surgery
What is done during vocal cordotomy?
Preoperative assessment of the person
If your doctor decides to perform a vocal cordectomy, you need to undergo a preoperative assessment to evaluate the following:
- Vocal cord functioning
- Airway examination
- Documentation of airway size
- Vocal quality
This assessment includes measurements of sound, airflow, and force, as well as your own impression of your vocal quality and breathing ability.
- You will be placed under general anesthesia for the procedure.
- Moistened surgical pellets will be placed in your subglottic space (the region below the vocal cords) to prevent heat damage to the neck tissue and other structures in the area.
- The larynx will be exposed, and the posterior (hind) part of the vocal cord will be incised with a CO2 laser because the posterior part plays a major role in air entry in and out of the larynx.
- Charred segments located in the lased areas will be cleaned.
Because the laser-separated edges heal quickly compared with knife incisions, there is very little scar formation. Hence, the impairment of voice quality is minimal. The average duration of the procedure is about 25 minutes.
- You will be administered intravenous steroids to prevent vocal cord edema (swelling).
- Oxygen saturation levels will be monitored for the first 24 hours post the surgery.
- Laryngopharyngeal reflux prophylaxis (a single 30-mg dose of oral lansoprazole) and a nonsteroidal anti-inflammatory agent along with antibiotics will be administered for about the next 16 days.
The entire healing process takes three months. Rarely, you may require a repeat procedure. If you have been treated for bilateral vocal cord paralysis with a tracheostomy in the past, you may now be eligible for laser cordotomy and closure of your tracheostomy.
Absolute voice rest; avoiding coughing, singing, and shouting, and taking regular steam inhalation may hasten your recovery.
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