Endoscopic arytenoid abduction lateropexy with para-arytenoid soft tissue reduction for the treatment of permanent bilateral vocal fold palsy.

PURPOSE: Endoscopic arytenoid abduction lateropexy (EAAL) is a reliable, minimally invasive technique for treating bilateral vocal fold palsy (BVFP). This study aimed to evaluate the safety and functional efficacy of a modified approach for EAAL that utilizes absorbable sutures and CO₂-laser para-arytenoid soft tissue reduction to achieve durable lateralization without the long-term use of foreign materials. METHODS: This study enrolled 15 patients with permanent BVFP following thyroid surgery, including 8 revisions after prior glottis-widening procedures. The technique involved temporary arytenoid fixation with an absorbable suture after soft tissue reduction and, when required, cricoarytenoid joint disarticulation. Peak inspiratory flow (PIF), maximum phonation time (MPT), Voice Handicap Index (VHI), and laryngeal function-specific quality-of-life (QoL) were assessed before and 1 and 12 months after surgery. Deglutition function was evaluated with fiberoptic endoscopic evaluation of swallowing (FEES) and the MD Anderson Dysphagia Inventory (MDADI) questionnaire. RESULTS: All patients immediately achieved a stable and durable airway without perioperative complications. Mean PIF increased significantly after surgery and remained stable at 12 months. MPT showed no significant change at either postoperative timepoint. VHI improved significantly throughout follow-up. MDADI scores improved early and remained significantly above baseline. QoL improved markedly in the early postoperative period and remained significantly increased at 12 months. FEES revealed physiological swallowing in 13/15 patients. Suture-related symptoms resolved after suture absorption. CONCLUSION: The modified EAAL with soft tissue reduction provides a stable airway while maintaining phonatory and swallowing functions. Temporary fixation ensures durable lateralization via paraglottic scarring, thereby minimizing long-term foreign body-related morbidity.