ELLEN M. FRIEDMAN, MD; ANDREW L. DE JONG, MD; MARCELLE SULEK, MD

HOUSTON, TEXAS

Traditionally, there have been 3 approaches to bilateral vocal fold dysfunction in the midline position: tracheostomy, vocal fold lateralization, and reanimation techniques. This report describes an adaptation of the CO2 laser partial transverse cordotomy used in adults and introduced by Kashima. The procedure is performed under microlaryngoscopy with unilateral vaporization of the posterior third of the true and false vocal cords, extending laterally to the thyroid cartilage. This surgery capitalizes on the inherent characteristics of the CO2 laser, namely, hemostasis, precision, reduced postoperative edema, and scarring. The laser allows for an endolaryngeal approach without extensive "hands-on" manipulation especially favorable in the small pediatric larynx. The goals of this surgery include airway ealargement, satisfactory voice, and no aspiration. We have performed this procedure on 4 children (4 to 13 years old). The C02 laser partial cordotomy was successful in all 4 patients. These results can be achieved during a short operative procedure that has been practical, well tolerated, and successful.