Predictors of Success Following Posterior Transverse Cordotomy and Arytenoidectomy for Bilateral Vocal Fold Paralysis

Sunday, October 18, 2026

2:54 PM - 3:00 PM PT

Location: 406B

Presenting Author(s)

Hetal K. Lad, BS

Ms.
Rutgers New Jersey Medical School
Newark, New Jersey, United States

Co-Author(s)

MM

Mal Mehari, BA

Medical Student
New Jersey Medical School, United States
GA

Gloria A. Abbas-Zadeh, BA

Medical Student
Rutgers New Jersey Medical School
MONROE TOWNSHIP, New Jersey, United States
SV

Sai Vendidandi, n/a

Medical Student
Rutgers New Jersey School of Medicine
Newark, New Jersey, United States
KY

Kenneth Yan, MD, PhD

Assistant Professor
Rutgers New Jersey Medical School
Newark, NJ, United States
DR

Dylan F. Roden, MD, MPH

Associate Professor
Rutgers
Newark, New Jersey, United States
SB

Soly Baredes, MD

Chairman
Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School
Newark, New Jersey, United States

Senior Author(s)

Rachel J. Kaye, MD

Associate Professor
Rutgers New Jersey Medical School
Newark, New Jersey, United States

Disclosure(s):

Kenneth Yan, MD, PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: CO₂ laser transverse posterior cordotomy (TPC) and arytenoidectomy (AD) are established surgical options to improve airway patency in patients with bilateral vocal fold immobility(BVFI) as alternatives to tracheotomy. Despite their widespread use, limited data exist on how perioperative management and patient characteristics influence revision risk and complications.

Methods: We conducted a retrospective cohort study of patients with BVFI undergoing posterior transverse cordotomy and/or arytenoidectomy at a tertiary center (2000–2025). Demographics, perioperative adjuncts, and postoperative outcomes were analyzed. Primary success was defined as revision-free recovery and decannulation, with secondary outcomes including complications and time to revision assessed using Kaplan–Meier analysis.

Results: 55 patients (mean age 56.1 years, 53% male) underwent BVFI surgery, including TPC alone (42%), TPC+AD (51%), and AD alone (7%), with median follow-up of 477 days. On multivariable analysis, intraoperative steroid injection (n=34, OR 0.24, 95% CI 0.05–0.93, p=0.0438) was protective while prior HN radiation (n=11, OR 7.64, 95% CI 2.06–33.7, p=0.0038) independently increased odds of revision. Intraoperative steroid injection (n=34,62%) was associated with higher revision-free survival (log-rank p=0.0017), while recurrence-free survival did not differ by procedure type (log-rank p=0.76). Compared with AD alone, TPC+AD had lower odds of revision (OR 0.01, p=0.023). Procedural success occurred in 63.6% of patients, with decannulation in 61.3% at a mean of 133 days. Complications included granuloma (13%), fibrosis (19%), and edema (32%), with aspiration in 11%. Postoperative antibiotic use, proton pump inhibitor therapy, and inhaled or oral corticosteroids were not associated with odds of revision surgery (all p>0.05).

Conclusions: Intraoperative steroid injection and TPC + AD approach were associated with improved revision-free outcomes, while prior radiation increased the risk of revision. These findings underscore the importance of patient-specific risk stratification.