Modified transoral CO2 laser posterior cordotomy for bilateral vocal fold paralysis: surgical and functional outcomes.

PURPOSE: To describe the surgical and functional outcomes of modified posterior cordotomy in patients with bilateral vocal fold paralysis (BVFP), with particular attention to airway function, swallowing, and voice outcomes. METHODS: This retrospective study included 30 patients with BVFP who underwent modified posterior cordotomy between June 2017 and August 2024. Preoperative and postoperative evaluation included videolaryngoscopy and patient-reported outcome measures, including the Voice Handicap Index (VHI-30), Eating Assessment Tool-10 (EAT-10), and Airway-Dysphonia-Voice-Swallowing (ADVS) scale. RESULTS: All 30 patients were women (mean age 55.53 years) who underwent modifiedposterior cordotomy for iatrogenic (100% post thyroidectomy) BVFP. Improvementswere observed in airway function ADVS (particularly A and D) and swallowing (EAT-10), with voice quality (VHI-30) showed no clinically meaningful postoperative worsening. All 7 tracheostomized patients (23%) were successfully decannulated post-surgery. PEF%(20/30 patients) showing a mean peak expiratory flow of 62.8% and a median of 64.5%(range, 35%-82%). CONCLUSIONS: Modified posterior cordotomy via transoral CO₂ laser microsurgery was associated with improved airway function and swallowing outcomes, with minimal impact on voice-related quality of life, and no requirement for revision surgery in patients with bilateral vocal fold paralysis.