Evaluation of the effect of endoscopic CO2 laser arytenoidectomy on re-operation for failed posterior cordotomy
Objective:To analyze the efficacy of endoscopic CO2 laser arytenoidectomy in treating bilateral vo-cal cord paralysis.Methods:Ninety-five patients who underwent endoscopic CO2 laser arytenoidectomy for bilater-al vocal cord paralysis at the First Affiliated Hospital of Naval Medical University(Changhai Hospital)of Shanghai from January 2009 to December 2022 were included in this study.Among them,59 patients underwent endoscopic CO2 laser arytenoidectomy as their first glottic enlargement surgery(Group A),while 36 patients,who had previ-ously undergone two unsuccessful CO2 laser-assisted posterior cordotomies,underwent endoscopic CO2 laser ary-tenoidectomy as a subsequent surgery(Group B).Swallowing function,electronic laryngoscopy,perceptual voice evaluation,and objective voice analysis indicators were statistically analyzed before and after surgery to evaluate clinical efficacy.Results:The extubation rate after the first surgery was 84.75％in Group A and 86.11％in Group B,with total extubation rates of 94.92％and 94.44％,respectively.There were no significant differences between the two groups in preoperative and postoperative swallowing function,glottic size,or various voice evalu-ation indicators(P＞.05).Within-group comparisons showed that postoperative swallowing function,glottic clo-sure during phonation,perceptual evaluations of G(grade of hoarseness),A(asthenia),and B(breathiness)signif-icantly worsened,with increased grades.The maximum transverse diameter of the posterior glottis during inspira-tion significantly increased,and the VHI-10 score was significantly higher postoperatively.Jitter,shimmer,and the harmonics-to-noise ratio significantly deteriorated,and maximum phonation time significantly shortened(P＜0.05).No significant differences were observed in postoperative R(roughness)and S(strain)compared to preop-erative values(P＞0.05).Conclusion:Endoscopic CO2 laser arytenoidectomy can impair voice quality to some ex-tent but effectively alleviates breathing difficulties in patients with bilateral vocal cord paralysis.For patients who did not achieve successful extubation with CO2 laser-assisted posterior cordotomy,endoscopic CO2 laser arytenoid-ectomy is an effective reoperative method,ensuring a high extubation rate while preserving certain voice functions.
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