The adjunctive role of application of Mitomycin C intraoeratively with posterior transverse Iaser cordotomy in treatment of bilateral abductor vocal fold paralysis

Abstract EN

Bilateral abductor vocal fold paralysis (BAVFP) is a common complication following thyroidectomy.

In those patients whose airway is compromised by the paralyzed vocal folds, tracheostomy is emergently indicated, which is, though life-saving, a stigmatizing mishap with significant impact on quality of life.

A significant proportion of afflicted patients recover recurrent laryngeal nerve function 6-12 months after the onset, and thus may get rid of the tracheostomy. However, patients who do not recover vocal fold mobility always seek to become independent of the tracheostomy tube. Dennis and Kashima (1989) have devised Posterior Transverse CO2 Laser Cordotomy (PTLC) in order to relief the obstruction at the posterior glottis.

Variable results for this procedure have been reported.

Granulation tissue with subsequent scar formation may be a cause for the varying results.

Mitomycin C (MMC), an anti-mitotic chemotherapeutic agent has been shown to reduce granulation and scar tissue formation in multiple studies using animal models in which airway scarring is induced.

MMC has also shown significant prevention of re-stenosis following surgical correction of laryngotracheal stenosis.

We report, for the first time, a case-control series of 23 patients with post-thyroidectomy BAVFP who have undergone PTLC.

The study group (12) had MMC adjuvant application during PTLC.

Thirteen patients had a tracheostomy prior to inclusion.

Three outcomes of the intervention were compared in the study and control groups: decannulation rate (for tracheostomized patients), dyspnea symptom scale (DSS) change for non-tracheostomized patients, and voice quality.

DSS was the only outcome that showed a statistically significant difference between the study and control groups.