Surgical managements of bilateral vocal fold paralysis: tracheotomy, cordotomy, arytenoidectomy, laterofixation

Bilateral vocal fold paralysis (BVFP) is characterized by the complete or partial inability to move the vocal folds. BVFP presents with inspiratory dyspnea resulting from airway narrowing at the glottic level, where both vocal folds are positioned paramedian. Historically, iatrogenic damage to the recurrent laryngeal nerves has been identified as a common cause of BVFP. This condition is often critical, necessitating immediate treatment such as intubation for short-term relief, and potentially surgical procedures like tracheostomy to address the compromised airway. The primary objective in managing BVFP is to alleviate dyspnea in affected patients. Treatment options include tracheostomy, arytenoidectomy, laterofixation, and cordotomy, each with varying degrees of effectiveness in improving airway function, though voice quality may be negatively impacted or remain unchanged. The diversity in study methodologies, the absence of large-scale controlled randomized trials, and the challenge of distinguishing BVFP from posterior glottic stenosis hinder the ability to definitively determine the superiority of one treatment approach over another.