The treatment of double vocal fold abduction palsy by CO2 laser arytenoidectomy under supported laryngoscopy requires reconstruction of the laryngeal airway while preserving articulatory function, which poses great difficulties for surgical treatment. In the next 70 years, the treatment of BVCP has gradually developed into three main modes, each with its own advantages and disadvantages: (1) external laryngeal approach arytenoid cartilage resection and vocal cord external transfer, which is more commonly used in Woodman type, but cannot preserve the articulatory function; (2) laryngeal nerve reinnervation: including nerve anastomosis and neuromuscular ring posterior arytenoid implantation, which has not been popularly used; (3) endolaryngeal approach arytenoid cartilage resection and vocal cord external transfer under the scope, which is difficult to control bleeding and mucosal edema during surgery. In 1984, Ossoff et al. first reported the application of CO2 laser microscopic arytenoid chondroidectomy, which has the characteristics of fine and accurate microsurgery. The postoperative reaction is mild, and the articulatory function is preserved, which makes up for the defects of the pure speculum surgery and the external cervical approach. From May 1994 to February 2000, 18 patients, 10 males and 8 females, aged 17-58 years, underwent laryngoscopic CO2 laser microscopic arytenoid chondroidectomy BVCP using general anesthesia. The duration of the disease ranged from 4 to 27 years. Etiology: post-operative thyroid, post-operative repair of congenital heart disease and unknown causes. Twelve of the cases had undergone tracheotomy before coming to the hospital. Surgical features: general anesthesia intubation, supported laryngoscopy to expose the posterior larynx, and the operative field including the arytenoid cartilage on the operative side and the posterior part of the vocal cords, the interarytenoid area, and the contralateral part of the arytenoid cartilage. The mucosa of the arytenoid cartilage is incised with a CO2 laser at 5-10 W. The laser makes an arc-shaped incision along the surface of the arytenoid eminence toward the tip of the arytenoids and between the arytenoid folds, separates the perichondrium to expose the arytenoid cartilage body, and removes the arytenoid cartilage and part of the arytenoid eminence from the cricoarytenoid joint. The mucosa on the surface of the arytenoid cartilage is preserved by reasonable design, and 2 to 3 stitches are used to eliminate the trauma, and the small trauma can be sprayed with biogel to avoid postoperative granulation. Intraoperatively, flumethasone 10mg was given intravenously to prevent laryngeal edema, and for those with tracheotomy, the tube was blocked the next day after surgery to encourage patients to breathe, speak and eat through the mouth. Among the 12 patients with tracheotomy, 9 patients had their tracheal tubes removed after 3-6 months of postoperative observation, and all of them maintained their conversation and pronunciation function, and their voice quality was slightly duller than before surgery, but it did not prevent language communication. CO2 laser microlaryngeal surgery has been developed since 1976 when Strong first performed it, because of its advantages of microscopic refinement, less bleeding, no edema, direct intraoperative judgment of the size of the new vocal fissure, no need for neck incision and better articulatory function, etc., so that arytenoid cartilage microdissection for BVCP has been developed. In 1984, Ossoff et al. reported the successful treatment of double vocal fold abduction palsy with CO2 laser arytenoid chondroidectomy under speculum, and then there were different modifications of this procedure, such as CO2 laser medial arytenoid chondroidectomy, in which a concave surface of the arytenoid cartilage was vaporized on the medial side of the arytenoid cartilage, posterior to the vocal folds, preserving the vocal fold prominence, muscle prominence and crico-arytenoid muscle, which resulted in the opening of the posterior part of the vocal folds by 1~2 mm. Remacle et al. reported a subtotal arytenoid cartilage resection in which a thin cartilage shell was preserved in the posterior part of the body of the arytenoid cartilage to avoid the mucosa of the arytenoid cartilage from sinking into the larynx and obstructing the airway during inspiration, so as to facilitate the stability of the arytenoid region after surgery and prevent misaspiration and posterior joint adhesions. The operation time is also limited to 30 min, thus reducing the incidence of postoperative laryngeal edema and even avoiding tracheotomy. The success criteria of surgery are generally determined by extubation or establishment of an effective airway with no difficulty in articulation. 1996 Remacle et al. used objective tests such as expiratory and inspiratory flow comparison, voice intensity, loudest time, voice quotient or audio analysis to assess articulatory function. Preventing postoperative granulation from obstructing the airway or posterior joint web formation is an important aspect of CO2 laser arytenoid chondroidectomy surgery. In order to prevent the infection of granulation on the laser wound, the mucosal wound was sutured to eliminate the wound in this group of cases, and no granulation was formed in any case, which shortened the postoperative recovery time. However, supporting microscopic suturing requires a high level of operator skill. Another measure to prevent scarring of the interlacunar area is to pay attention to avoid damage from the thermal effect of the laser.