Bigenzahn W; Hoefler H. Minimally invasive laser surgery for the treatment of bilateral vocal cord paralysis. Laryngoscope 1996 Jun;106(6):791-3.

Introduction: Bilateral vocal cord paralysis is commonly caused by lesions of the recurrent laryngeal nerves, which in many cases result from surgery on the thyroid. If both vocal cords are paralyzed in the median or paramedian position, the airway is severely compromised and patients suffer respiratory distress requiring surgical intervention.

From a phoniatric point of view, surgical management should aim at a compromise between respiratory and phonatory performance. Therefore, extralaryngeal interventions that result in severe dysphonia or aphonia are less desirable than endolaryngeal approaches that partially preserve phonatory function. With the introduction of the carbon dioxide (CO2) laser for microsurgery in the larynx, specific techniques for the surgical management of bilateral recurrent nerve paralysis have been developed. Resection of the vocal process of the arytenoid cartilage is a minimally invasive procedure that is especially suitable for nontracheotomized patients who are suffering from respiratory distress but still have good voice quality.

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