Laser Cordotomy: Procedure, Recovery and Results for Vocal Cord Paralysis
Updated: Nov 5
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: November 2026 · How we review
Quick Answer: What is a laser cordotomy?
A laser cordotomy is a minimally invasive procedure that widens a narrow airway. Working through the mouth, a surgeon uses a laser to make a small cut in one or both vocal cords, creating more space for air to flow between them. It treats bilateral vocal cord paralysis, when both cords stay stuck close together. [1]
What the research says
Most people can breathe without a tracheostomy tube afterward. A systematic review of bilateral vocal fold paralysis surgery found that unilateral and bilateral posterior transverse cordotomy were linked to a 95.1% decannulation rate, though voice quality often worsened. (Lechien et al., Otolaryngology–Head and Neck Surgery, 2024) [2]
Results are similar across airway-widening surgeries. A meta-analysis of 102 studies and 2,802 patients found a decannulation rate of 96% after posterior cordotomy, with no significant difference between surgical techniques. (Titulaer et al., Frontiers in Surgery, 2022) [3]
Breathing improved for every patient in a small study. In 18 adults treated with a CO2 laser posterior cordotomy, all had less breathlessness and satisfactory voice afterward; two needed another procedure. (Khalil & Abdel Tawab, Clinical Medicine Insights: Ear, Nose and Throat, 2014) [4]
Key takeaways
A laser cordotomy widens the airway by making a small laser cut in one or both vocal cords. [1]
It treats bilateral vocal cord paralysis, which can make speaking, swallowing and breathing hard. [1]
It is done through the mouth under general anesthesia and takes about 30 to 60 minutes. [1]
Most people stay in the hospital about 24 hours, and full recovery takes about three months. [1]
It is far less invasive than a tracheostomy and can sometimes allow a tracheostomy tube to be removed. [1]
How does a laser cordotomy work?
A laser cordotomy works by opening space between paralyzed vocal cords. In vocal cord paralysis affecting both sides, neither cord opens and closes properly, so they sit close together and leave only a very narrow airway. A small laser incision lets air flow more freely. [1]
Only a small part of the cord is cut; the rest is left in place.
Because the airway gets wider, the voice may become breathier. Surgeons aim for a balance between easier breathing and a usable voice. [2]
Who needs a laser cordotomy?
A laser cordotomy is for people with bilateral vocal cord paralysis whose narrow airway causes problems with breathing, speaking or swallowing. Most cases of bilateral vocal fold paralysis are caused by medical procedures, such as neck or thyroid surgery. [1] [2]
In the past, many people with this condition needed a tracheostomy, an opening in the windpipe through the neck with a breathing tube. People who already have a tracheostomy may still be candidates; if so, the surgeon may close it during the cordotomy. [1]
Laser cordotomy vs cordectomy
Cordotomy | Cordectomy | |
What is done | A small incision in one or both vocal cords | Part or all of a vocal cord is removed |
Rest of the cord | Left intact | Partly or fully removed |
Main use | Vocal cord paralysis | Laryngeal cancer |
Sources: [1]
How do you prepare for a laser cordotomy?
Before a laser cordotomy, your team measures how well you breathe and speak so they can compare results afterward. Your healthcare team gives you specific preparation instructions. [1]
A speech-language pathologist (SLP) records a video of your vocal cords to document airway size and cord position. A second video after surgery shows how much things have improved. [1]
What happens during a laser cordotomy?
During a laser cordotomy, you are under general anesthesia while the surgeon works through your mouth with a camera and a focused laser. The procedure usually takes about 30 to 60 minutes. [1]
There is no cut on the outside of the neck.
A laryngoscope (camera) is passed through the mouth and throat to view the voice box and vocal cords.
A small, moist sponge is placed below the vocal cords to protect nearby tissue.
A focused laser makes an incision in one or both vocal cords.
Sources: [1]
What is recovery like after a laser cordotomy?
Most people stay in the hospital about 24 hours for monitoring, and full recovery takes about three months. [1]
Some people need a second (revision) cordotomy for the best result.
Stage | What to expect |
In the hospital | About 24 hours of monitoring with IV steroids to prevent swelling |
First 1 to 3 weeks | Antibiotics, oral steroids and anti-reflux medicine may be prescribed |
While healing | Vocal rest; steam inhalation may soothe the cords |
About 3 months | Full recovery |
Sources: [1]
During vocal rest, avoid coughing, shouting, singing and speaking loudly. [1]
What are the benefits and risks of a laser cordotomy?
The main benefit is a wider airway without a long-term tracheostomy. A laser cordotomy can improve breathing, swallowing and voice function while maintaining quality of life, and in some people it allows a tracheostomy tube to be removed (decannulation). [1]
It has fewer risks than a tracheostomy, but possible complications include: [1]
Bleeding in the voice box
Injury to the lips, teeth or palate from the laryngoscope
Scar tissue around the vocal cords
Vocal cord swelling
Across studies, complications mainly involve swelling, granulomas, fibrosis and scarring, and voice quality may get worse as the airway widens. [2]
When should you call your doctor?
Contact your healthcare provider if you have: [1]
Trouble breathing
Difficulty swallowing
Injuries to the lips or teeth
Conclusion
A laser cordotomy is a short, minimally invasive way to open a narrow airway caused by bilateral vocal cord paralysis. It often makes breathing easier and can help people avoid or remove a tracheostomy, though the voice may change.
If you have been offered a laser cordotomy, ask your surgeon how much airway they plan to open and what changes to your voice you should expect.
Keep learning: Read our guide to how the vocal cords work or learn about thyroplasty, a surgery for one paralyzed cord. For more background, see this vocal fold paralysis overview from ASHA.
FAQ
What is a laser cordotomy?
A laser cordotomy is a minimally invasive procedure that uses a laser to make a small cut in one or both vocal cords to widen the airway.
What is a laser cordotomy used for?
It treats bilateral vocal cord paralysis, when both cords stay close together and the airway is very narrow.
How long does a laser cordotomy take?
The procedure usually takes about 30 to 60 minutes under general anesthesia.
Is a laser cordotomy done through the neck?
No. The surgeon works through the mouth with a laryngoscope, so there is no outside cut on the neck.
How long is the hospital stay after a laser cordotomy?
Most people stay about 24 hours for monitoring and receive IV steroids to prevent swelling.
How long does recovery take after a laser cordotomy?
Full recovery takes about three months, and some people need a revision procedure.
Will a laser cordotomy change my voice?
It can. Widening the airway often makes the voice breathier, so surgeons balance breathing and voice.
What are the risks of a laser cordotomy?
Risks include bleeding in the voice box, injury to the lips, teeth or palate, scar tissue and vocal cord swelling.
Can a laser cordotomy replace a tracheostomy?
It is far less invasive than a tracheostomy and can sometimes allow a tracheostomy tube to be removed.
What is the difference between a cordotomy and a cordectomy?
A cordotomy is a small cut that leaves the cord intact; a cordectomy removes part or all of a cord, usually for cancer.
How do I prepare for a laser cordotomy?
Before surgery, your team measures your breathing, airflow when you speak and vocal cord movement, and a speech-language pathologist records a video of your vocal cords to document airway size, so results can be compared afterward [1]. Your healthcare team will give you specific preparation instructions [1].
Does a laser cordotomy hurt, and what anesthesia is used?
You're under general anesthesia for the procedure, which usually takes about 30 to 60 minutes, so you don't feel anything during it [1]. Most people then stay in the hospital about 24 hours for monitoring [1].
When should I call my doctor after a laser cordotomy?
Contact your healthcare provider if you have trouble breathing, difficulty swallowing, or injuries to your lips or teeth [1].
Related Reading
What Is Vocal Cord Paralysis? A Plain-Language Guide to the Voice Problem That Can Also Make Breathing and Swallowing Hard explains the condition a laser cordotomy treats.
Your Voice: Vocal Cords Anatomy, Function, and Health explains how the vocal cords open and close to let you breathe and speak.
References
Cleveland Clinic. Laser Cordotomy for Vocal Cords. Cleveland Clinic. Last updated November 14, 2023. https://my.clevelandclinic.org/health/procedures/laser-cordotomy
Lechien JR, Hans S, Mau T. Management of Bilateral Vocal Fold Paralysis: A Systematic Review. Otolaryngol Head Neck Surg. 2024;170(3):724-735. PMID 38123531. https://doi.org/10.1002/ohn.616
Titulaer K, Schlattmann P, Guntinas-Lichius O. Surgery for bilateral vocal fold paralysis: Systematic review and meta-analysis. Front Surg. 2022;9:956338. PMID 35937593. https://doi.org/10.3389/fsurg.2022.956338
Khalil MA, Abdel Tawab HM. Laser Posterior Cordotomy: Is it a Good Choice in Treating Bilateral Vocal Fold Abductor Paralysis? Clin Med Insights Ear Nose Throat. 2014;7:13-17. PMID 25057244. https://doi.org/10.4137/CMENT.S15888
Medical disclaimer
This article is for general education only and does not replace advice from a qualified healthcare professional. Talk to your doctor about your own diagnosis and treatment, and seek emergency care right away for severe or sudden symptoms.
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