Abstractbook als PDF downloaden - hno kongress 2011

R6 – O13
Bilateral vocal cord paralysis treatment and chalenges
Spiric P, Spiric S, Gnjatic M, Vojnovic V
ENT Clinic, Clinic center Banja Luka, Bosnia and Herzegovina
Introduction: Bilateral vocal cord paralysis (BVCP) is life threatening medical condition. It
can be result of different medical conditions but mostly is caused by surgical intervention on
thyroid, neck or lungs. Without proper treatment these patient ends with tracheostomy as
permanent solution. Up today there is no ideal treatment solution for this medical condition.
Material and methods: We analyzed 33 patients with diagnosis of BVCP. Data were
presented in tables, diagrams and pictures with basic statistical calculation
Results: In period 2002-2011 we had 33 patients treated with various surgical techniques.
We used laser posterior cordotomy, laterofixation and tracheostomy. Most of the cases
required multiple and combined procedures. All patients with finished treatment in our clinic
gain acceptable breathing capacity for everyday activities.
Conclusions: BVCP is serious and demanding medical condition. Modern surgical
techniques provides sufficient outcome but with low level of personal satisfaction. We have to
estimate current treatment options insufficient and seek for better solutions in future.
R6 – O14
Endoscopic dynamic solution for permanent bilateral vocal cord palsy; is that a
real option?
Rovó László, Madani Sahram, Sztanó Balázs, Szakács László, Jóri József, Kiss
József Géza
University of Szeged, Department of Otolaryngology and Head and Neck Surgery, Szeged, Hungary
Objectives: Standard endoscopic solutions for bilateral vocal cord palsy (VCP) give
generally a poor compromise between breathing and voicing. These interventions are based
mainly on the different resection of the glottic structures providing a static enlargement of the
airway. Recent studies revealed a spontaneous adduction recovery even in most cases of
permanent VCP, thus theoretically a reliable glottis enlarging procedure which preserves the
participating anatomical structures in this process may provide a more favorable compromise
in terms of voice and breathing.
Methods: Endoscopic arytenoid lateropexy (EAL) is an effective technique based on the
arytenoid abduction with sutures. Preservation of laryngeal structures ensures the above
mentioned criteria. Respiratory andphoniatric results (acoustics, perception,
videostroboscopy and self-evaluation) of consecutive 25 patients with bilateral permanent
VCP were assessed with one year follow up.
Results: 13 patients had incomplete dominantlyadduction contralateral vocal cord recovery,
with slightly or moderate impaired voice quality. 6 patients had socially acceptable voice, but
false vocal cord phonation. 6 patients had complete palsy with poor phoniatric outcome. All
of the patients had remarkably increased stable spirometric result allowing an improved
quality of life.
Conclusion: Dynamic solution of bilateral VCP is a hot topic of laryngology, however,
routine clinical efficacy of laryngeal reinnervation and laryngeal pacing has not been proven
unambiguously. In 76% in this series the simple EAL allowed an immediately and remarkably
improved breathing coupled good or acceptable voice due to the regenerated vocal cord
adduction. This may mean a simpler dynamic solution for most bilateral permanent BVCP.
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