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Abstract
Vocal fold paralysis may be unilateral or bilateral. Stridor is the most common presenting symptom in bilateral cases .In the past, tracheotomy has traditionally been recommended for these patients. Dysphonia is not a typical feature of bilateral VFP, since most cases are abductor paralysis, with the folds in close apposition to each other. There are a number of causes of VFP, including iatrogenic, neurological disorders, birth trauma, and idiopathic.
We aim in this study to answer this question:
Which has better functional results for the patients of bilateral vocal fold paralysis lateralization of folds or laser cordotomy?
Studies include published medical articles concerning surgical management of bilateral vocal fold paralysis. Thorough searching of the Medline data base in last 30 years using the following keywords:
(1) Lateralization of vocal folds
(2) Cordopexy
(3) Laser cordotomy
(4) Laser cordotomy and lateralization of vocal folds
(5) Arytenoidectomy versus cordopexy
(6) Cordopexy versus laser cordotomy
(7) Lateralization of vocal fold versus laser cordotomy
The search was limited to the articles in the last 30 years from 1979/1/21 to 2009/1/21 yielded a total number of 87 articles and abstracts.
Screening and evaluation of previous studies according to the following:
1-cases with bilateral vocal fold paralysis.
2-cases underwent surgical intervention to correct this problem.
The screening form is used by investigators to screen the articles yielded by the Medline search after blinding the articles regarding authors and journal of publication. Only articles fulfilling the criteria of screening are included for further steps of data collection, analysis and reporting.
(I) Relevant articles: which were the articles that include the above mentioned keywords.
(II) Irrelevant articles: which were articles that missed one or more of the above mentioned keywords.
(III) Included articles: which were articles that were fulfilled the following inclusion criteria:
1-Articles in English language and study on human.
2 –Articles that include cases of bilateral abductor vocal fold paralysis
3- Sample size was mentioned.
4- Functional outcome was present as regard decanulation rate.
5-Articles published in last 30 years
Data analysis was performed utilizing Meta-analytic Review Manager (RevMan 5) soft ware, using data collected from the previous articles comparing between laser and lateralization. For increasing the statistical power of the current the study, by increasing the sample size, pooling of data was done from4 papers of laser only, together with 3papers of lateralization only, provided that the preoperative condition was bilateral abductor vocal fold paralysis.
Pooling of data done as regard papers related to laser there were total number of 97 patients 24 of them not decanulated.Pooling of data done as regard papers related to lateralization with total number of 109 patients 21 of them not decanulated.
Then analysis done by Review Manager (RevMan 5) to studies as 2 studies with pooled data.