Tratamiento quirúrgico endoscópico con láser diodo de la parálisis laríngea en addución

Resumen

Presentamos nuestra experiencia relativa al período 1998-2004 sobre la utilidad del láser diodo por contacto en la realización de una hemicordectomía posterior endoscópica, según la técnica de Dennis-Kashima modificada para el tratamiento de la parálisis laríngea en addución. Durante este período tratamos 18 pacientes. La parálisis era iatrógena en 5 casos, post-traumática en 2 casos y central en 11 casos. El seguimiento medio fue de 20 meses. La disnea mejoró en todos los pacientes; los nueve traquetomizados fueron decanulados en los dos meses siguientes. La calidad de la voz se consideró buena en 16 pacientes (88%). No hubo ninguna complicación post-operatoria. En conclusión, la cordectomía posterior endoscópica realizada con láser diodo por contacto es una técnica fiable y eficaz en el tratamiento de la disnea secundaria a parálisis laríngea bilateral en addución, garantizando un espacio respiratorio suficiente sin alterar la función deglutoria y conservando una aceptable calidad de voz.

Abstract

Several surgical procedures have been proposed for the treatment of respiratory distress secondary to bilateral vocal cord paralysis. The aim of all surgical techniques used is to restore a glottic lumen sufficient to guarantee adequate breathing through the natural airway, without tracheotomy and preserving an acceptable phonatory quality. In this study we present our experience from 1998 to 2004 concerning the use of the diode contact laser for a modified Dennis-Kashima posterior endoscopic cordectomy (extended to the false homolateral chord in 3 cases and to the homolateral arytenoid vocal process in 6 cases). 18 patients (15 male, 3 female) were treated; the age range was 35-84 years. The etiology of paralysis varied: iatrogenic post-thyroidectomy and post-thoracic surgery in 5 cases (28%), post-traumatic in 2 cases (11%), secondary to a central lesion in 11 (61%). The operation was carried out with a diode contact laser (60W; 810 nm). Follow-up was 20 months. Dyspnea improved in all patients; the 9 tracheostomized patients were decannulated within 2 months after surgery. Final voice quality was subjectively good in 16 patients (88%). None of patients had any complications after surgery. In conclusion, the endoscopic posterior cordectomy performed by contact diode laser is an effective and reliable method for the treatment of dyspnea secondary to bilateral laryngeal paralysis, guaranteing a sufficient airway without impairing swallowing and maintaining acceptable voice quality.