Laser Cordotomy
A laser cordotomy is a minimally invasive procedure to treat bilateral vocal cord paralysis (vocal fold paralysis). A surgeon makes a small incision in one or both vocal cords. The incision widens your airway, allowing you to breathe better. You may have a laser cordotomy even if you’ve already had a tracheostomy.
A laser cordotomy is a minimally invasive medical procedure that a healthcare provider may use to widen your airway. During the procedure, a surgeon uses a laser to make a small cut (incision) in one or both of your vocal cords. The incision allows space for air to flow between your vocal cords.
A laser cordotomy treats bilateral vocal cord paralysis (vocal fold paralysis). In bilateral vocal cord paralysis, neither of your vocal cords open and close as they should. Your vocal cords are stuck close together, resulting in a very narrow airway. A narrow airway can cause problems with speaking, swallowing and breathing.
Your healthcare team will tell you how to prepare for a laser cordotomy. Before treatment, your team will assess your:
- Airflow and force when you speak.
- Breathing ability.
- Vocal cord activity.
- Vocal quality.
A speech-language pathologist (SLP) will take video images of your vocal cords. These images document your airway size and vocal cord position. The pathologist will take another video after surgery to measure improvements.
Before the procedure, you’ll receive general anesthesia to stay in a sleeplike state. During the procedure, your surgeon will:
- Position a special camera called a laryngoscope through your mouth and throat to view your larynx (voice box) and vocal cords.
- Place a small, moistened sponge in the area below your vocal cords (subglottic space) to prevent damage to the tissues around your vocal cords.
- Use a focused laser beam to make an incision in one or both vocal cords.
A laser cordotomy procedure usually takes about 30 to 60 minutes.
After the procedure, you’ll stay in the hospital for about 24 hours for monitoring. You’ll receive intravenous (IV) steroids to prevent vocal cord swelling during your stay. Your healthcare provider may prescribe antibiotics, oral steroids and anti-reflux medicines for you to take for one to three weeks while you heal.
Before laser cordotomy was an option, many people needed a tracheostomy to treat bilateral vocal cord paralysis. In a tracheostomy, a surgeon creates an opening in your windpipe (trachea) from the outside of your neck. This procedure allows you to breathe through a tube connected to the opening.
Compared to tracheostomy, a laser cordotomy is far less invasive. It can improve your breathing, swallowing and voice function while maintaining a higher quality of life. Sometimes, a laser cordotomy can be used to help someone with a tracheostomy achieve decannulation (tracheostomy removal).
Laser cordotomy has fewer risks than a tracheostomy, making it a preferred treatment option. But potential complications may include:
- Bleeding in your voice box.
- Injury to your lips, teeth or palate when inserting the laryngoscope.
- Scar tissue around your vocal cords.
- Vocal cord swelling.
Recovering from a laser cordotomy takes about three months. In some instances, you may need a revision cordotomy to get the best results.
You may inhale steam to help soothe your vocal cords during healing. Your healthcare provider may also recommend vocal rest to speed up your recovery. During vocal rest, you should avoid:
- Coughing.
- Shouting.
- Singing.
- Speaking loudly.
When should I call my healthcare provider after a laser cordotomy?
Call your healthcare provider if you notice any signs of complications after a laser cordotomy, including:
- Difficulty swallowing.
- Injuries around your lips or teeth.
- Trouble breathing.
References
- American Speech-Language-Hearing Association. Vocal Fold Paralysis (https://www.asha.org/public/speech/disorders/vocal-fold-paralysis/). Accessed 11/14/2023.
- Khalil MA, Abdel Tawab HM. Laser Posterior Cordotomy: Is it a Good Choice in Treating Bilateral Vocal Fold Abductor Paralysis? (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085108/) Clin Med Insights Ear Nose Throat. 2014 Jul 3;7:13-7. Accessed 11/14/2023.
- Salik I, Winters R. Bilateral Vocal Cord Paralysis (https://www.ncbi.nlm.nih.gov/books/NBK560852/?report=reader). 2023 Jul 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Accessed 11/14/2023.
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