Modified Coblator Posterior Cordotomy For The Management of Bilateral Vocal Fold Paralysis

Abstract

Background: Bilateral vocal fold paralysis (BVFP) can cause severe airway narrowing, stridor, and the need for tracheostomy. Posterior cordotomy is used to widen the glottic airway, but treatment should also consider voice, swallowing, granulation, restenosis, and the need for revision.

Objective: To evaluate airway and functional outcomes after modified Coblator posterior cordotomy in patients with BVFP.

Methods: This single-arm clinical surgical series included 28 patients treated at Rizgary Teaching Hospital and Zheen International Hospital in Erbil, Kurdistan Region, Iraq, between January 2020 and February 2026. All patients underwent left-sided, arytenoid-preserving modified posterior cordotomy using a Coblator setting of 6/3. Breathing was assessed using the modified Medical Research Council (mMRC) dyspnea grade. Decannulation, stridor, airway success with and without revision, granulation, restenosis, voice change, aspiration, and second-look findings were recorded. Paired mMRC change was assessed using a two-sided exact sign test.

Results: The mean age was 44.9 ± 15.0 years and 71.4% of patients were female. All cases were post-thyroidectomy BVFP. Mean mMRC decreased from 3.14 ± 0.80 before surgery to 0.43 ± 0.50 after surgery; 27 patients (96.4%) improved and one was unchanged (p < 0.001). Stridor resolved in all 26 symptomatic patients. All six patients with a pre-existing tracheostomy were decannulated by 30 days. A successful recorded airway outcome without revision was achieved in 25/28 patients (89.3%). Three patients (10.7%) developed granulation and restenosis and required revision; all three later had a successful recorded airway outcome. Mild voice deterioration was recorded in 17 patients (60.7%). Two patients (7.1%) had transient aspiration, and no persistent aspiration occurred.

Conclusion: Modified Coblator posterior cordotomy was associated with marked breathing improvement, complete decannulation among tracheostomized patients, and a high final recorded airway success rate. Revision was needed in a small number of patients, while voice changes were mainly mild and persistent aspiration was not recorded.