Bilateral abductor cord palsy occurs in up to 7% of patients undergoing total thyroidectomy. Surgical management using tracheostomy is the treatment of choice for patients with severe respiratory distress but has poor psychosocial acceptance and results in permanent changes in anatomy. Other surgical techniques have poor voice outcomes. We present a case series of patients of bilateral abductor cord palsy post total thyroidectomy for papillary thyroid carcinoma who underwent Botulinum injection into the adductor muscles (Cricothyroid ± Lateral cricoarytenoid) and were able to manage without tracheostomy. Botulinum paralytic toxin could help as a temporary non-surgical measure or as a bridge till spontaneous recovery of nerve function.
