Laser Cordectomy due to bilateral vocal cord palsy

Dr M R Islam

Bilateral vocal cord palsy is an uncommon finding, but can occur after neck surgery or rarely due to a growth in the larynx, pharynx, mediastinum or in thyroid malignancy. It causes severe respiratory distress and stridor and may even cause death of the patient. Hence, early diagnosis and treatment is essential to save the life of the patient.

A 65 year old female patient came to the outpatient department with severe respiratory distress, dysphagia, and progressive difficulty in speech for past 12 months. Her condition became so severe during last 3 months that she could not lie on the bed at night and had to spend her nights in sitting position or standing upright. She had a history of stroke one year back.

On clinical examination, the patient was found restless, with respiratory difficulty and stridor, she was cachexic and dehydrated. FOL (Fibre optic laryngoscopy) showed bilateral vocal cord palsy (Abductor palsy) with severely compromised airway.

After counseling both the patient and her attendant regarding treatment plan and outcome, tracheostomy was done to bypass the blocking part of her respiratory passage which allowed her an easier breathing. Six weeks later, Laser Cordectomy was done; on 4th post-operative day (POD) corking of tracheostomy tube was done to make the patient breathe normally. On 7th POD tracheostomy tube was removed and wound was closed. On regular follow up, within 2 weeks, her voice improved, her food habit and her airway for normal respiration were found adequate.