Laser cordotomy

Overview

A laser cordotomy is a minimally invasive technique that uses a laser to make a small incision in one or both vocal cords, recommended for treating difficulty speaking, swallowing, or breathing due to bilateral vocal cord paralysis, and can improve airflow by widening the airway.

Laser cordotomy is a less invasive alternative to traditional tracheostomy for individuals with bilateral vocal cord paralysis, and it can be performed even after a tracheostomy to provide additional breathing support. This procedure significantly improves voice, swallowing, and breathing functions, and in some cases, may even allow for the removal of a tracheostomy tube. Prior to its development, many patients required a more invasive tracheostomy, making laser cordotomy a valuable advancement in treatment.

Reasons for undergoing the procedure

Bilateral vocal cord paralysis occurs when both vocal cords fail to open and close as they should, remaining tightly positioned, which narrows the airway and can cause difficulties with breathing, swallowing, and speaking. This condition is treated with a laser cordotomy.

Risks

Generally, laser cordotomy is considered safer than a tracheostomy and is often the favored treatment option.

As with any procedure, a laser cordotomy comes with certain risks, such as:

• Vocal cord swelling
• Tissue scarring around the vocal cords
• Damage to the palate, teeth, or lips during laryngoscope insertion
• Voice box bleeding

Before the procedure

Before a laser cordotomy, a speech-language pathologist (SLP) captures video images of the vocal cords to assess their position and airway size.

The following is often evaluated:

• Force and airflow during speech
• Vocal cord activity
• Quality of voice
• Capacity to breathe

After surgery, the SLP takes another video to track improvements in the vocal function and airway.

During the procedure

The laser cordotomy procedure typically lasts between 30 and 60 minutes. General anesthesia is often administered during the procedure to ensure comfort.

These are done during the procedure:

• Insert a specialized camera, called a laryngoscope, through the patient’s mouth and throat to visualize the larynx or voice box, and vocal cords.
• Place a small, moistened sponge beneath the vocal cords in the subglottic space to protect surrounding tissues.
• Use a focused laser beam to make an incision in one or both vocal cords.

After the procedure

One is typically monitored in the hospital for approximately 24 hours. During this time, intravenous (IV) steroids are administered to reduce the risk of vocal cord swelling.

To support healing process after the procedure, medications are often prescribed, such as:

• Oral steroids
• Anti-acid reflux
• Antibiotics

Outcome

Recovery from a laser cordotomy generally takes about three months, though some individuals may need a follow-up procedure to achieve the best outcomes. During recovery, recommendations often include steam inhalation and avoiding using the voice excessively to facilitate healing.

It’s crucial to monitor for any signs of complications following the procedure and seek immediate medical care if issues such as breathing difficulties, damage to the teeth or lips, or trouble swallowing arise. Additionally, activities that strain the vocal cords, like coughing, shouting, singing, and loud speaking, should be avoided.