Bilateral vocal fold paralysis is a disorder characterized by complete immobility of both vocal folds, often occurring as a result of surgical injury or malignancy. This condition leads to voicing, swallowing, and/or breathing difficulty. If the vocal folds are paralyzed in an open position, voicing can be negatively affected. Swallowing may also be difficult if the vocal folds cannot close to protect the airway, leading to risk for aspiration pneumonia.

Patients with bilateral vocal fold paralysis often develop significant difficulty breathing as the vocal folds can no longer open appropriately when breathing in or out. Depending on the position of the paralyzed vocal folds, surgery may be required to either bypass the larynx (voice box) or widen the narrowed portion of the vocal folds in order for the patient to breathe safely. Contraindications for these different procedures depend on each individual’s medical history and should be thoroughly discussed with the surgeon.

Pre-procedure Considerations 

As there are multiple surgical options available to treat airway compromise due to bilateral vocal fold paralysis, it is important that the patient have a thorough discussion with the surgeon regarding the side effects and reversibility of each procedure. Each procedure carries different risks of affecting the patient’s voice quality, breathing, and swallowing function.

Summary of Procedures

  • Tracheostomy - A surgical opening into the trachea below the level of the vocal folds to bypass the narrowed portion of the airway 
  • Transverse cordotomy – Removal of the posterior portion of the vocal fold to improve the airway
  • Arytenoidectomy - Removal of the arytenoid cartilage(s) to improve the airway
  • Vocal Fold Fat Injection Augmentation - bulking material can be injected into the vocal folds to push them closer together to improve voice
  • Laryngeal Framework Surgery - This procedure involves placement of a synthetic implant and/or stitches to reposition the vocal folds or cartilages surrounding the voice box

Post-Procedure Guidelines 

Patients should be monitored for voice quality, swallowing function, and breathing. Patients may also benefit from swallowing therapy or voice therapy to maximize their quality of life, optimize their voice, improve swallowing, and decrease aspiration risk. If necessary, modifications and reversal of procedures may be required in the future.