Clinical Efficacy Analysis of Unilateral Modified Arytenoidectomy for Bilateral Vocal Fold Paralysis.

PURPOSE: To explore the clinical efficacy of unilateral modified arytenoidectomy (UMA) in the treatment of bilateral vocal fold paralysis(BVFP) based on animal models.

METHODS

The UMA which had been tested in excised canine larynges with simulated BVFP was adapted into a clinical technique. The characteristics of this surgical technique involve contouring of the arytenoid cartilage. The procedure expands the vocal fold respiratory region and subglottic space of the arytenoid cartilage while preserving the muscular process to maintain partial vocal fold muscle function. A retrospective analysis was conducted on 19 patients diagnosed with BVFP who were admitted to the Department of Voice Medicine, Zhongshan Hospital of Xiamen University between April 2019 and November 2023. These patients underwent CO2 laser arytenoid cartilage partial resection using a modified surgical technique. Dyspnea scores, voice handicap index scale (VHI-10), and subjective and objective acoustic analysis were collected pre-op and post-op assessments to evaluate the clinical efficacy.

RESULTS

Data analysis of patients at 6 months post-op showed VHI-10: pre-op (21.68 ± 12.40) score, post-op (16.21 ± 7.68) score (p = 0.033); mMRC Dyspnea Scale: pre-op (2.79 ± 0.71) score, post-op (0.58 ± 0.69) score (p < 0.001); fundamental frequency (F0): pre-op (175.54 ± 50.72) Hz, post-op (190.36 ± 39.28) Hz (p = 0.196); maximum vocalization time (MPT): pre-op (4.69 ± 4.30) s, post-op (5.98 ± 3.24) s (p = 0.098); Jitter: pre-op (6.12 ± 6.14)%, post-op(2.39 ± 3.77)% (p = 0.090); Shimmer: pre-op (22.27 ± 11.29)%, post-op (13.02 ± 6.71)% (p = 0.048); Grade (G): pre-op (2.56 ± 0.73), post-op (1.78 ± 0.44) (p = 0.008); roughness (R): pre-op (2.44 ± 0.73), post-op (1.67 ± 0.50) (p = 0.020); breathiness (B): pre-op (2.11 ± 1.05), post-op (1.67 ± 0.50) (p = 0.102); asthenia (A): pre-op (1.33 ± 0.87), post-op (1.00 ± 0.00) (p = 0.257); and strain (S): pre-op (1.44 ± 0.88), post-op (0.56 ± 0.73) (p = 0.046).

CONCLUSIONS

The oral CO2 laser UMA is safe, minimally invasive, and highly effective. Postoperative voice quality shows significant improvement compared to the preoperative state. Moreover, the postoperative extubation rate can reach 100%, striking a balance between improving ventilation and preserving voice function to a considerable extent.