http://pubs.jamanetwork.com/ en-us Mon, 01 Apr 2013 00:00:00 GMT Tue, 30 Apr 2013 21:46:28 GMT Silverchair editor@pubs.jamanetwork.com webmaster@pubs.jamanetwork.com http://pubs.jamanetwork.com/article.aspx?articleID=1669844 Mon, 01 Apr 2013 00:00:00 GMT Özdemir S, Tuncer Ü, Tarkan Ö, et al. <span class="paragraphSection"><div class="boxTitle">Importance</div>Treatment of bilateral vocal cord paralysis is a considerable challenge for otolaryngologists. Many surgical techniques have been developed for the management of this entity to eliminate the need for tracheotomy.<div class="boxTitle">Objective</div>To evaluate the success of the unilateral carbon dioxide laser endoscopic posterior cordotomy technique for bilateral abductor vocal cord paralysis.<div class="boxTitle">Design</div>A retrospective study.<div class="boxTitle">Setting</div>A university department of otolaryngology–head and neck surgery.<div class="boxTitle">Participants</div>Sixty-six patients (58 women and 8 men) diagnosed as having bilateral abductor vocal cord paralysis.<div class="boxTitle">Intervention</div>Endoscopic posterior cordotomy with the carbon dioxide laser.<div class="boxTitle">Main Outcome Measures</div>Decannulation and postoperative voice quality and exercise tolerance.<div class="boxTitle">Results</div>The most common etiologic factor was recurrent laryngeal nerve paralysis after thyroidectomy, observed in 61 patients (92%); an unknown cause was observed in 5 (8%). Unilateral cordotomy sufficed in 58 patients (88%). We performed revision procedures for vocal cord granuloma in 4 patients (6%). Bilateral cordotomy was required for 4 patients (6%) with an insufficient airway. Postoperative tracheotomy was needed for only 4 patients owing to the edema in the operation site. These patients underwent decannulation within a mean period of 7 days. No patient had poor postoperative exercise tolerance. We found no statistically significant difference between the preoperative and postoperative voice quality using the 10-item Turkish version of the Voice Handicap Index.<div class="boxTitle">Conclusions and Relevance</div>Carbon dioxide laser endoscopic posterior cordotomy is a safe, minimally invasive, effective technique with a short operation time. A bilateral approach or a revision procedure is rarely required. Bilateral cordotomy should be reserved for patients with insufficient airway passage with unilateral cordotomy.</span> 139 4 401 404 10.1001/jamaoto.2013.41 http://pubs.jamanetwork.com/article.aspx?articleID=1669844