Department of Otolaryngology, Elsan Hospital, Paris, France.
Department of Otolaryngology-Head & Neck Surgery, Foch Hospital, School of Medicine, UFR Simone Veil, Université Versailles Saint-Quentin-en-Yvelines (Paris Saclay University), Paris, France.
Otolaryngol Head Neck Surg. 2024 Mar;170(3):724-735. doi: 10.1002/ohn.616. Epub 2023 Dec 20.
To review the current literature about epidemiology, etiologies and surgical management of bilateral vocal fold paralysis (BVFP).
PubMED, Scopus, and Cochrane Library.
A systematic review of the literature on epidemiology, etiologies, and management of adult patients with BVFP was conducted through preferred reporting items for systematic reviews and meta-analyses statements by 2 investigators.
Of the 360 identified papers, 245 were screened, and of these 55 were considered for review. The majority (76.6%) of BVFP cases are iatrogenic. BVFP requires immediate tracheotomy in 36.2% of cases. Laterofixation of the vocal fold was described in 9 studies and is a cost-effective alternative procedure to tracheotomy while awaiting potential recovery. Unilateral and bilateral posterior transverse cordotomy outcomes were reported in 9 and 7 studies, respectively. Both approaches are associated with a 95.1% decannulation rate, adequate airway volume, but voice quality worsening. Unilateral/bilateral partial arytenoidectomy data were described in 4 studies, which reported lower decannulation rate (83%) and better voice quality outcome than cordotomy. Revision rates and complications vary across studies, with complications mainly involving edema, granuloma, fibrosis, and scarring. Selective posterior cricoarytenoid reinnervation is being performed by more surgeons and should be a promising addition to the BVFP surgical armamentarium.
Depending on techniques, the management of BVFP may be associated with several degrees of airway improvements while worsened or unchanged voice quality. The heterogeneity between studies, the lack of large-cohort controlled randomized studies and the confusion with posterior glottic stenosis limit the draw of clear conclusion about the superiority of some techniques over others.
综述双侧声带麻痹（BVFP）的流行病学、病因学和外科治疗的当前文献。
Pubmed、Scopus 和 Cochrane 图书馆。
通过 2 名调查员按照系统评价和荟萃分析报告的首选条目，对成人双侧声带麻痹患者的流行病学、病因学和管理的文献进行系统综述。
在 360 篇已确定的论文中，有 245 篇进行了筛选，其中 55 篇被认为适合进行综述。大多数（76.6%）BVFP 病例是医源性的。36.2%的病例需要立即行气管切开术。9 项研究描述了声带外侧固定术，这是一种在等待潜在恢复时替代气管切开术的经济有效的方法。9 项研究和 7 项研究分别报道了单侧和双侧后横向声带切开术的结果。这两种方法都与 95.1%的拔管率、足够的气道容量相关，但声音质量恶化。4 项研究描述了单侧/双侧部分杓状软骨切除术的数据，报告了较低的拔管率（83%）和更好的声音质量结果，优于声带切开术。修订率和并发症在不同的研究中有所不同，并发症主要涉及水肿、肉芽肿、纤维化和瘢痕形成。选择性后环杓肌神经再支配术正由更多的外科医生进行，这应该是 BVFP 外科治疗的一个有前途的补充。
根据技术的不同，BVFP 的治疗可能与气道改善的不同程度相关，而声音质量则恶化或保持不变。由于研究之间的异质性、缺乏大样本对照随机研究以及与后声门狭窄的混淆，限制了对某些技术优于其他技术的明确结论的得出。
