Laser-assisted endoscopic submucosal medial arytenoidectomy (LESMA)

Abstract

Various surgical techniques have been proposed for the management of patients with bilateral vocal fold paralysis (VFP) or posterior glottic stenosis (PGS), which make use of external and endoscopic approaches. The purpose of these surgical treatments is to restore an adequate airway without disturbing voice quality and swallowing. It has been known that medial arytenoidectomy and cordotomy using laser, which partially resects the medial portion of the arytenoids, can preserve the airway and voice quality without damage on the membranous vocal fold.1 However, laser arytenoidectomy and cordotomy may result in granulation or scar tissue formation after surgery, which could fail to restore the adequate airway. Submucous medial arytenoidectomy can prevent granulation tissue formation, thus accelerating healing processes and improving treatment outcomes. We herein describe our experiences in the management of bilateral VFP and PGS by combining posterior transverse partial cordotomy, as described by Dennis and Kashima,2 with modified method of submucosal medial arytenoidectomy, as described by Crumley.