CO2 Laser Surgical Management of Laryngeal Diplegia in Adduction: A Series of 46 Cases
DOI:
https://doi.org/10.47363/JOLRR/2026(5)147Keywords:
Bilateral Vocal Fold Paralysis, Laryngeal Diplegia, Arytenoidectomy, Subtotal Arytenoidectomy, Posterior Cordectomy, CO2 Laser, Postoperative ResultsAbstract
Introduction: Bilateral vocal fold paralysis in closure (BVFP) can lead to suffocating respiratory distress and various techniques for glottic enlargement have been developed in recent years to replace tracheotomy. Endo-laryngeal surgery with CO2 laser has a central place in this therapeutic arsenal.
Objective: The aim of this work is to prove the effectiveness of our techniques of treatment of BVFP with the CO2 laser, the durability of long-term success, and to compare the rates of failure, complications and recurrence of our methods by analysing the postoperative breathing, phonation and swallowing.
Method: This is both a retrospective and prospective study on a series of 46 patients treated with CO2 laser either by subtotal arytenoidectomy (SA), or Dennis and Kashima or Reker posterior cordectomy (PC).
Results: The mean age was 56 years with 98% female. 44 patients presented with dyspneic BVFP secondary to thyroidectomy, total in 38 patients, and whose indication was a benign goitre in 82% of cases. Respiratory distress led to tracheotomy in 21 cases with an average delay of 10 months.
Postoperatively, the tracheostomised patients were decannulated on average 5 months later, the non-tracheotomised patients were successful after extubation with the disappearance of their dyspnoea. The voice was satisfactory according to the patient's feeling, and the subjective reception. There were no postoperative false airways. Recurrence occurred mainly in patients who had undergone PC and had insufficient glottic expansion or cord regrowth with a return to the clinical presentation of laryngeal stenosis. The overall recurrence time was a maximum of 14 months.
Conclusion: Endo-laryngeal laser surgery is better than external surgery with a lower cost than a simple tracheostomy. SA and PC are equally effective in improving the breathing of the BVFP patient, although PC often requires revision surgery to achieve definitive success, but in the long term the success rates are equivalent.
