Surgery and Clinical Practice
Open AccessCold Steel Endoscopic Posterior Partial Cordectomy for Bilateral Abductor Vocal Cord Paralysis Post-Thyroidectomy: A Case Report and Literature Review
Authors: Enoch A Dahilo, Elizabeth Omosule.
Abstract
Background: Bilateral vocal cord paralysis following total thyroidectomy can lead to life-threatening respiratory distress. Conventional management, including tracheostomy, is associated with significant morbidity. Endoscopic procedures like posterior cordectomy- typically with coblation or LASER- are alternatives that aim to avoid permanent tracheostomies, which is particularly relevant in resource-poor settings. This report details the management of a patient who presented with progressive symptoms two years post-thyroidectomy.Methods: A 40-year-old policewoman with bilateral abductor paralysis underwent an endoscopy-assisted cold steel posterior cordectomy. Under general anaesthesia, a rigid laryngoscope was used to confirm paramedian vocal cord positioning. The left cord, which was less mobile was operated on. After injecting adrenaline, a pair of micro-laryngeal scissors was used to make a 1 cm curvilinear incision to excise the posterior two-thirds of the left vocal cord, preserving the arytenoid to maintain an adequate glottic space.Results: The patient was successfully extubated and discharged three days post-surgery. One month later, a video laryngoscopy revealed a polyp at the excision site, causing some respiratory distress. Following a course of oral and inhaled steroids, subsequent examinations showed a progressive improvement. By the third month, the polyp had completely resolved, and the patient's symptoms were gone. They were satisfied with their voice and reported no further aspiration or choking.Conclusion: Cold steel Endoscopic posterior cordectomy is still an effective treatment option for patients with bilateral vocal cord paralysis following total thyroidectomy. As demonstrated by this case, careful surgical technique, and appropriate postoperative management, can lead to excellent long-term functional outcomes.
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