Reversible lateralization of the paralyzed vocal cord without tracheostomy.

The initial management of bilateral abductor vocal cord paralysis is usually tracheostomy. It is proposed that a reversible endoscopic vocal cord lateral fixation would avoid this morbid procedure. The operation is performed by laryngoscopy utilizing the endo-extralaryngeal suture technique of Lichtenberger. Two polypropylene sutures are looped over one of the paralyzed vocal cords and brought out through the neck skin. A small incision is made, and the sutures are secured in the sternohyoid muscle. If movement of one or both vocal cords returns, the sutures are removed. Sixty-one of 63 cases were successful. In 53 cases, the airway became stable, without return of function. In 8 cases, one or both of the vocal cords became mobile 3 to 4 months after the operation. The reversible endo-extralaryngeal lateralization of the vocal cord using the above suture technique ensures a stable airway immediately. This technique avoids the need for tracheostomy in cases of bilateral abductor vocal cord paralysis.