Laser cordotomy

Overview

A laser cordotomy is a minimally invasive technique that uses a laser to make a tiny incision in one or both vocal cords. It is recommended to treat conditions, such as difficulty speaking, swallowing, or breathing due to vocal cord paralysis.

A laser cordotomy can improve airflow through widening the airway. This procedure is less invasive than traditional methods like a tracheostomy. It can also be performed even after a tracheostomy, providing additional breathing support. 

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. 

Risk

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

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

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

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:

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

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

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

• Oral steroids
• Anti-acid reflux
• Antibiotics

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.

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.

Before the development of laser cordotomy, many individuals with bilateral vocal cord paralysis often required a tracheostomy, which is more invasive. Laser cordotomy offers a less invasive alternative that can significantly improve functions such as voice, swallowing, and breathing. For some, this procedure may even allow for the removal of a tracheostomy tube.