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Prevention and management of bilateral vocal cord paralysis by and after thyroid surgery.

Following the great tradition established in the Szent Rókus Hospital and Institutions by author's predecessor Prof. Aurel Réthi, there have been more than 300 patients operated on for treatment of laryngotracheal stenosis. The vast majority of the cases referred to the department suffering from bilateral vocal cord paralysis were the consequences of thyroid surgery and its complications. Confronted with this challenging clinical scenario, the author became determined to focus not only on reconstruction but also on prevention. For example, all thyreoidectomies are performed with identification and preservation of the recurrent nerves. As the author's department is a center for laryngotracheal reconstruction, patients from different institutions were treated with larynx dilating operations, benefiting from the newly developed additional techniques. With the goal of refining alternatives to previous glottis dilating operations, new methods have been worked out for the management of bilateral vocal cord paralysis based on our endo-extralaryngeal suture technique. These recently popularized approaches consist of two operations, an irreversible one and a reversible one. The first operation is performed on patients whose vocal cords are paralyzed. This irreversible operation can be performed with and without arytenoidectomy. These operations were successful in 94 out of 99 patients. The second operation was the reversible endo-extralaryngeal lateralization, which was carried out in 63 patients, 61 of which were successful. In the reversible technique the suture was not removed if the cords remained paralyzed. If there was evidence of return of vocal cord function, the suture was removed, thus eliminating the need for further dilating operations. The author feels that these two operations are quite successful because the medial mucous membrane of the vocal cord is preserved, avoiding scar and granuloma formation. The operations may be performed without any kind of tracheostomy. These are significant advantages over most other glottic dilating operations.