Bilateral Vocal Fold Paralysis

The Upper Airway is that part of the airway (the breathing passage) that extends from the nose to the trachea, and includes the nasal cavities, the throat (the pharynx) and the voicebox (the larynx). Narrowing in the upper airway may cause serious symptoms, such as shortness of breath (especially on exertion) and stridor, a high pitched sound heard during inspiration (breathing in or inhaling), or during both inspiration and expiration (taking a breathing out or exhaling).

Narrowing of the larynx caused by scarring (posterior glottic stenosis or subglottic stenosis), narrowing of the trachea caused by scarring (tracheal stenosis), bilateral vocal fold paralysis, throat infections and tumours in the throat are the main conditions associated with stridor. These conditions can be life threatening, especially if symptoms develop suddenly and quickly.

Bilateral Vocal Fold Paralysis

Narrowing of the airway may also result from paralysis of both vocal folds, leading to an inability to fully open the vocal folds to allow for an adequate intake of air. Bilateral vocal fold paralysis most commonly occurs as a complication of surgery, but may also result from intubation, neurological disorders or from cancers affecting organs near to the larynx.

Bilateral vocal fold paralysis is often treated with laser surgery to one of both vocal folds to enlarge the size of the airway.  This is performed via the mouth using a laryngoscope under general anaesthetic in the operating room. Therefore, this procedure is called Microlaryngoscopy & Laser Cordotomy.

When laser treatment of bilateral vocal fold paralysis is not effective, or is not possible, a Combined Glottic Reconstruction may be performed. This is a procedure in which the front of the larynx is opened to allow access to the back of the larynx (posterior glottis). The back of the larynx is then split in half, and a piece of cartilage (usually harvested from the chest wall) is inserted between the two halves to enlarge the size of the airway. Part of the lining of the throat is then advanced into the larynx to cover the cartilage to improve healing. This procedure is performed through an incision in the front of the neck under general anaesthetic in the operating room. The recovery postop requires several days in hospital afterwards, and a temporary tracheostomy for several weeks after the surgery.