Our Experience with Kashimas Procedure for Bilateral Abductor Vocal Cord Palsy

Document Type : Original


Department of Otorhinolaryngology, Head and Neck Surgery, Govt. Medical College Srinagar, Srinagar, India.


Kashima operation, also known as endoscopic laser cordotomy is used for the treatment of bilateral abductor vocal cord palsy where the glottis chink is made posteriorly, sufficient enough for patient to breathe comfortably without any strider.
Materials and Methods:
This Clinical Trial Was Performed On 12 Patients[1] with Bilateral Abductor Vocal Cord Paralysis. All Patients Underwent Kashimas Procedure and Post-Operative Voice, Respiratory and Deglutition Function Were Evaluated.
75% of patients were females and the mean age of patients was 40.9 ±9.13 years. In our patients, the most common etiology of bilateral vocal cord palsy was thyroid surgery (n=10, 83.33%).There was a significant improvement in breathing after surgery (P=0.001). After the procedure, 70% of patient had mild voice handicap score, and MPT was in normal range in 91.6% of cases.
Kashimas procedure is a satisfactory surgical treatment for treating bilateral vocal cord palsy in regards to strider. No aspiration was seen in any of the patients post-surgery and voice outcome of these patients was also satisfactory.



  1. Li Y, Pearce EC, Mainthia R, Athavale SM, Dang J, Ashmead DH, et al. Comparison of ventilation and voice outcomes between unilateral laryngeal pacing and unilateral cordotomy for the treatment of bilateral vocal fold paralysis. ORL J Otorhinolaryngol Relat Spec2013;75:68-73.
  2. Benninger MS, Gillen JB, Altman JS. Changing etiology of vocal fold immobility. Laryngoscope 1998; 108:1346-50.  
  3. Tucker HM. Rehabilitation of the immobile vocal fold. In: Fried MP, editor. The Larynx. A Multidisciplinary Approach. 2nd ed. St. Louis: Mosby; 1996. p. 209-18. 
  4. Jackson C. Ventriculocordectomy. A new operation for the cure of goitrous glottic stenosis. ArchSurg1922; 4:257-74.
  5. Zealear DL, Billante CR, Courey MS, Netterville JL, Paniello RC, Sanders I, et al. Reanimation of the paralyzed human larynx with an implantable electrical stimulation device. Laryngoscope 2003; 113: 1149-56.
  6. Thornell WC. Intralaryngeal approach for arytenoidectomy in bilateral abductor vocal cord paralysis.ArchOtolaryngol1948;47:505-8.
  7. Dennis DP, Kashima H. Carbon dioxide laser posterior cordectomy for treatment of bilateral vocalcordparalysis.AnnOtolRhinolLaryngol1989; 98: 930-4.
  8. Remacle M, Lawson G, Mayné A, Jamart J. Subtotal CO 2 laser arytenoidectomy by endoscopic approach for treatment of bilateral cord immobility in adduction. Ann OtolRhinolLaryngol 1996;105:
  9. Plouin-Gaudon I, Lawson G, Jamart J, Remacle M. Subtotal carbon dioxide laser arytenoidectomy for the treatment of bilateral vocal fold immobility: Long term results. Ann OtolRhinolLaryngol 2005; 114:11521.  
  10. Oswal VH, Gandhi SS. Endoscopic laser management of bilateral abductor palsy. Indian J Otolaryngol Head Neck Surg 2009,61:47-51.  
  11. Dennis DP, Kashima H.Carbon dioxide laser posterior cordectomy for treatment of bilateral vocal cord paralysis. Ann Otol Laryngol 1989 Dec, 98(12 Pt 1):930-934.
  12. Seddon HJ. Three types of nerve injuries. Brain 1943; 66:237.
  13. Francesco Dispenza, Treatment of bilateral vocal cord paralysis following permanent recurrent laryngeal nerve injury. American Journal of Otolaryngology–Head and Neck Medicine and Surgery 33 (2012) 285–288.
  14.    Hans Edmund Eckel Cordectomy versus Arytenoidectomy in the Management of Bilateral Vocal Cord Paralysis the Annals of otology, rhinology, and laryngology 103(11):852-7. December 1994.
  15.    Raghavendra rao, vijendra shenoy, Vishnu Prasad. A comparative study of laser posterior cordotomy and vocal cord laterization.egyptian journal of EAR, Nose Throat and allied sciences (2015) 16, 255-258.
  16.  Nitish VirmaniJyoti Dabholkar, Laser-assisted posterior cordotomy for bilateral vocal fold paralysis: Our experience journal of head$neck physicians and surgeons .2016,vol4 issue1 page 23-28.
  17. Manju E Issac. Effect of Kashimas Surgery in bilateral abductor vocal cord palsy.IJOPL,January-june 2017;(1):10-12.
  18.  Eckel HE, Thumfart M, Wassermann K, Vössing M, Thumfart WF. Cordectomy versus arytenoidec- tomy in the management of bilateral vocal cord paralysis.Ann Otol Rhinol Laryngol 1994;103:852-7. 
  19. Lawson G, Remacle M, Hamoir M, Jamart J. Posterior cordectomy and subtotal arytenoidectomy for the treatment of bilateral vocal fold immobility: Functional results. J Voice 1996;10:314-9.