Introduction: Unilateral vocal fold flaccid paralysis (UVFFP) could be responsible for dysphonia as well as exertional dyspnea secondary to paradoxical vocal fold adduction on inspiration. Vocal fold augmentation techniques usually improve phonation with the risk of worsening breathing. Endoscopic glottis-widening procedures improve breathing while worsening phonation in these patients. Hereby we present a novel technique of reconstructive transoral laser microsurgery (R-TLM) that augments UVFFP while lateralizing the arytenoid and posterior part of the vocal fold, thus improving breathing without worsening and even ameliorating phonation.
Material and methods: Patients with UVFFP with exertional dyspnea with or without dysphonia were included in this report. The vocal fold is augmented by harvesting the aryepiglottic fold soft tissues and the upper part of the arytenoid and placing them into the paraglottic space as a pedicled microflap, thus augmenting the anterior two thirds of the vocal fold while lateralizing the remaining arytenoid and posterior third of the vocal fold by an internal traction suture to improve airway. Postoperative breathing, phonation and swallowing were assessed.
Results:Fifteen cases are reported in the study. Follow-up evaluations ranged from 6 to 24 months. All cases showed successful and durable improvement of breathing and phonation. None required tracheostomy or gastrostomy pre- or postoperatively.
Conclusion: Augmentation-lateralization is a novel, safe, and effective minimally invasive technique that allows airway improvement with good results on phonation in patients with challenging UVFFP with airway obstruction