Endoscopic Laser Medial Arytenoidectomy for Airway Management in Bilateral Laryngeal Paralysis

A review of our recent experience in patients with bilateral laryngeal paralysis is described. While we continue to use phrenic nerve transfers in patients with mobile arytenoids, patients with fixed arytenoids generally require some sort of vocal cord lateralization, either by arytenoidectomy and arytenoidopexy or by partial vocal cord resection. The endoscopic laser medial arytenoidectomy is a convenient and effective method for opening the posterior glottic airway. One arytenoid is reduced medially with the carbon dioxide laser. After about 3 months the opposite arytenoid can be treated similarly, if necessary. The procedure does not appear to affect arytenoid mobility, as the posterior commissure mucosa and underlying interarytenoid muscle are protected and hence unaffected by the procedure. Those patients with at least one mobile arytenoid cartilage are candidates for posterior cricoarytenoid muscle reinnervation. Although ansa cervicalis and phrenic nerve techniques have been described, the author has concentrated efforts on the phrenic nerve. This report describes the endoscopic laser medial arytenoidectomy procedure, while the phrenic nerve patients will be reported in a subsequent manuscript.