Table 1.

Summary of treatment options for BVFP

Treatment modality for BVFP	Indication	Pros	Cons
Tracheostomy	Acute dyspnea; temporary management of BVFP	Immediate relief of airway obstruction; greater improvement of ventilation compared to static procedures; no revision surgery required	Destructive of normal tissues; psychosocial impairment; scar formation; daily care of open wound required; decreased quality of life
Arytenoidectomy	Permantant management of BVFP; patients who want to be decannulated or avoid tracheostomy	Quick, effective enlargement of glottis to return breathing through mouth without dyscosmesis; can be combined with cordotomy; more cost-effective than tracheostomy	Irreversible; deterioration of voice; scar or granuloma formation; aspiration; may need revision surgery
Cordotomy	Permantant management of BVFP; patients who want to be decannulated or avoid tracheostomy	Quick, effective enlargement of glottis to return breathing through mouth without dyscosmesis; can be combined with arytenoidectomy; more cost-effective than tracheostomy; less tendency for aspiration than arytenoidectomy	Irreversible; deterioration of voice; scar or granuloma formation; aspiration; may need revision surgery
Laterofixation	Temporary management of the airway, with expectation of recovery of laryngeal function or avoidance of tracheostomy	Reversible; alternative to tracheostomy; greater improvement of airway, better voice quality, and less revision rate than arytenoidectomy and cordotomy; may be performed with other endoscopic procedures	Complications such as hoarseness, need for adjustment, remedialization, dysphagia or aspiration
Reinnervation	Patients that have non-atrophic viable muscles maintained through synkinetic reinnervation	A promising procedure that may allow return of spontaneous vocal fold abduction; non-distructive and doesn’t impair adductory functions	Technically more difficult; human trials are limited; potential diaphragmatic paralysis
Laryngeal pacing	Patients that have non-atrophic viable muscles maintained through synkinetic reinnervation	Greater ventilatory improvement reported than any other approach; no compromise of voice or swallowing	Still experimental with only 2 human trials; complicated procedure; more expensive than enlargement or lateralization approaches; device has to be replaced every 5–10 years
Botox injection	Temporary management of synkinetic larynx	Less invasive; short-term improvement in ventilation; little effect on voice or swallowing	Repeated injections are required; human trials are limited
Neuromodulation	Recently injured RLNs; muscles still denervated and nerve regenerating prior to synkinetic reinnervation	From canine studies, electrical neuromuscular conditioning promotes selective reinnervation of muscles, minimizes synkinesis and restores ventilation to normal	Experimental; no human trial
Gene therapy	BVFP caused by neurodegenerative diseases	Less invasive; could promote nerve regeneration and prevent muscle atrophy	Experimental; no human trial; not effective in preventing synkinesis; neuronal damage by viral vectors
Stem cell therapy	BVFP caused by neurodegenerative diseases	Could promote nerve regeneration and prevent muscle atrophy	Experimental; no human trial; not effective in preventing synkinesis; issues associated with issolation, culture and survival of stem cells

BVFP, bilateral vocal fold paralysis; Botox, botulinum toxin; RLN, recurrent laryngeal nerve.