Transverse Cordotomy

Transverse cordotomy is an endoscopic surgical procedure performed on the posterior portion of the vocal cord to improve the airway at the level of the larynx. The procedure was first described, to our knowledge, by Haskins Kashima at Johns Hopkins University.

Transverse cordotomy is most commonly performed for bilateral vocal cord paralysis, in which both vocal cords fail to open adequately during breathing. It may also be used in cases of glottic stenosis, where injury and subsequent scarring have caused the vocal cords to fuse or narrow the airway.

The Logistics

A laser cut is made from tip of vocal process and continued laterally. It is as if the thyroarytenoid (TA) muscle is transected from the arytenoid cartilage. Nerve supply comes into the TA muscle from posterolateral, and so there may be not only anterior retraction of the muscle but some degree of denervation. Voice is expected to be drastically weakened early postoperatively but then to partially and sometimes largely return with healing.

Patients typically undergo transverse cordotomy because of tracheotomy dependence or significant shortness of breath, especially with exertion.

Inherent to both the condition and its surgical treatment is a trade-off between voice and breathing. Transverse cordotomy necessarily sacrifices some voice quality in order to gain a safer and more functional airway. For many patients, this balance results in improved quality of life by reducing breathing limitation and, in some cases, eliminating the need for a tracheotomy.

Dr. Bastian believes a superior procedure has supplanted older methods of airway enlargement such as transverse cordotomy, arytenoidectomy, Lichtenberg needle lateralization, etc. Each of those procedures can work very well, of course, but the penalty to voice seems less predictable than after posterior commissuroplasty. That better procedure is described here.