Therapy of bilateral vocal fold paralysis

Terapija pacijenata s obostranom paralizom glasnica (engl. bilateral vocal fold paralysis, BVFP) predstavlja veliki izazov otorinolaringolozima i kirurzima glave i vrata. Postoje brojne kirurške metode koje se koriste u svrhu terapije bolesnika s obostranom paralizom glasnica. U ovom radu prikupljeni su i analizirani podatci o kliničkim karakteristikama, etiologiji i kirurškom zbrinjavanju pacijenata s BVFP-om te opisane dostupne kirurške metode i pristupi za pacijente s BVFP-om, a ti podatci su potom uspoređeni s aktualnom medicinskom literaturom. Podaci o dobi i spolu bolesnika, etiologiji paralize glasnica, kirurškom liječenju te vrsti i broju reoperacija preuzeti su iz bolničkog informacijskog sustava (BIS). Ovim retrospektivnom istraživanju obuhvaćeno je 19 ispitanika s BVFP-om koji su liječeni od 2007. do 2020. godine. Jedanaest (58%) bolesnika bile su žene, a 8 (42%) muškarci i srednja dob pri prvom kirurškom liječenju bila je 62,5 godina (raspon 36-75 godina). Najčešći uzrok u 10/19 bolesnika bila je tireoidektomija, a na drugom mjestu nepoznata etiologija, moždani udar i karcinom pluća uzrokovali su BVFP u po 2 bolesnika. U ostala tri bolesnika uzrok je bila politrauma, apsces vrata i obostrana operacija karotidnih arterija. Kao primarna kirurška intervencija traheotomija je učinjena u 11 bolesnika, dok je u ostalih 8 učinjen transoralni endolaringealni zahvat. Najčešći zahvat među njima bila je subtotalna aritenoidektomija (60%), zatim kordektomija (33%) i stražnja kordotomija (7%). Pet bolesnika liječeno je kirurški više puta. Objektivna procjena respiracije, fonacije i gutanja nije rađena rutinski. Sveukupne kliničke značajke i kirurško liječenje BVFP-a bolesnika u našem istraživanju bilo je u skladu s medicinskom literaturom. Niti za jednu od kirurških tehnika nije u dosadašnjoj literaturi dokazna funkcionalna prednost zbog relativno malog broja slučajeva u populaciji i nedostatka međunarodnih standarda i protokola za evaluaciju glasa i disanja.Therapy of patients with BVFP presents a major challenge to otorhinolaryngologists and head and neck surgeons. There are several surgical methods used to treat patients with unilateral or BVFP. This paper collects and presents data on the etiology and surgical care of patients with BVFP and describes the available surgical methods and approaches for patients with BVFP, and these data are then compared with the current medical literature. Data on the age and sex of patients, the etiology of vocal fold paralysis, surgical treatment, and the type and number of reoperations were taken from the hospital information system. This retrospective study includes 19 subjects with BVFP who were treated from 2007-2020. Eleven (58%) patients were women and 8 (42%) men and the mean age at first surgical treatment was 62.5 years (range 36–75 years). The most common cause, 10/19 patients, was thyroidectomy, followed by an unknown etiology, stroke and lung cancer in 2 (10.5%) patients for each cause. In the other three patients, the cause was polytrauma, neck abscess, and bilateral carotid artery surgery. As a primary surgical intervention, tracheotomy was performed in 11 patients, while in the remaining 8 one of the transoral endolaryngeal procedures was performed. The most common among them was subtotal arytenoidectomy (60%), followed by cordectomy (33%) and posterior cordotomy (7%). Five patients were surgically treated more than once. Clinical features and surgical treatment of BVFP patients in our research were the same as in the medical literature. There is no proven functional advantage for any of the surgical techniques in the literature so far due to the relatively small number of cases in the population and the lack of international standards and evaluation protocols for voice and breathing