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Miyauchi A, Fujishima M, Masuoka H, Sasaki T, Miya A, Ishisaka T, Adachi S, Kawano S, Matsunaga A, Yamamoto M, Higashiyama T, Ito Y, Onoda N, Kihara M. Ansa Cervicalis External Branch Anastomosis to Restore High Tone Voice in Thyroid Surgery. Laryngoscope 2024; 134:3868-3873. [PMID: 38450749 DOI: 10.1002/lary.31377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Injury to the external branch of the superior laryngeal nerve (EBSLN) causes low-pitch voice and voice fatigue, particularly in female subjects, and available treatments are limited. Here, we assess a novel surgical procedure to restore a high-tone voice: ansa cervicalis to EBSLN anastomosis (A-E anastomosis). METHODS Between November 2012 and April 2022, 13 patients (12 female) underwent unilateral EBSLN resection and A-E anastomosis, while 20 (16 female) underwent EBSLN resection during thyroid surgery. Patients (4494 women and 1025 men) with normal laryngoscopy scheduled for thyroid surgery served as normal controls. Phonatory function was examined using a Phonation Analyzer PA-1000 preoperatively and intermittently postoperatively. RESULTS In patients who underwent A-E anastomosis, high-tone voice pitch decreased significantly postoperatively (673.9-471.5 Hz, p = 0.047), with restoration achieved within 5 months. The mean voice pitch in female patients who underwent A-E anastomosis, EBSLN resection, and controls were 580.4, 522.8, and 682.0 Hz, respectively, indicating a significant decrease in EBSLN resection patients than controls (p = 0.002). The (mean - 1SD) of high-tone voice pitch in female controls was 497 Hz; exceeding this may indicate recovery to a high-tone voice. Overall, 73% (8/11) of A-E anastomosis patients exceeded this value, which was marginally larger than the 43% (6/14) who underwent EBSLN resection. Data on male subjects are limited. There were no cases of adverse functional or cosmetic events. CONCLUSIONS A-E anastomosis, a novel simple procedure, restored high-tone voice to some extent without any adverse events and thus warrants further investigation. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3868-3873, 2024.
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Affiliation(s)
| | | | | | - Takahiro Sasaki
- Department of Head and Neck Surgery, Kuma Hospital, Kobe, Japan
| | - Akihiro Miya
- Department of Surgery, Kuma Hospital, Kobe, Japan
| | - Tomo Ishisaka
- Department of Head and Neck Surgery, Kuma Hospital, Kobe, Japan
| | - Shiori Adachi
- Department of Head and Neck Surgery, Kuma Hospital, Kobe, Japan
| | | | | | | | | | - Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Kobe, Japan
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Mackiewicz-Nartowicz H, Nawrocka L, Burduk P, Sinkiewicz A. Voice Rehabilitation After Laryngeal Transplantation: Own Experience. J Voice 2024:S0892-1997(24)00021-3. [PMID: 38443266 DOI: 10.1016/j.jvoice.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/26/2024] [Accepted: 01/30/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND AND PURPOSE Laryngeal transplantation (LT) remains an infrequently performed procedure due to well-defined and limited medical indications. The challenges include a very complicated surgery, continuous immunosuppressive treatment, as well as post-transplant rehabilitation of voice, speech, and swallowing. The aim of this paper is to describe a model of voice and speech rehabilitation after LT, based on our own experience. STUDY DESIGN Observational study. METHOD Presented here are the rehabilitation processes of two patients who had previously undergone LT as well as their pre- and postrehabilitation voice outcomes. Both patients underwent voice, speech, and swallowing rehabilitation in the fifth month after LT. RESULTS One of the patients had a significant improvement in voice quality. While, the other did not regain his natural, sonorous voice, but he scored very high on a voice self-assessment test. CONCLUSION Voice rehabilitation after LT is a complex and long-term process that requires the involvement of a team of specialists. The optimal anatomical conditions restored during surgery, the patient's motivation and the support of professionals make it possible to return to normal verbal communication.
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Affiliation(s)
- Hanna Mackiewicz-Nartowicz
- Department of Otolaryngology, Audiology and Phoniatrics, University Hospital No. 2, Collegium Medicum, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.
| | - Lidia Nawrocka
- Department of Otolaryngology, Audiology and Phoniatrics, University Hospital No. 2, Collegium Medicum, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Paweł Burduk
- Department of Otolaryngology, Audiology and Phoniatrics, University Hospital No. 2, Collegium Medicum, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Anna Sinkiewicz
- Department of Otolaryngology, Audiology and Phoniatrics, University Hospital No. 2, Collegium Medicum, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
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Onifade A, Vincent E, Tolley N. Systematic review and meta-analysis of laryngeal reinnervation techniques in adults with unilateral and bilateral vocal fold palsies. J Laryngol Otol 2023:1-15. [PMID: 37982255 DOI: 10.1017/s0022215123001950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
OBJECTIVE To evaluate the outcomes of reinnervation techniques for the treatment of adult unilateral vocal fold paralysis and bilateral vocal fold paralysis. METHODS A literature review was conducted in the Embase and Medline databases in English, with no limitations on the publication date. The outcome parameters of interest included visual, subjective perceptual, acoustic, aerodynamic analysis and electromyography. A meta-analysis with a random-effects model and inverse variance was calculated. RESULTS The systematic Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach resulted in 27 studies, totalling 803 patients (747 unilateral cases and 56 bilateral cases). Thyroid cancer and/or surgery had caused unilateral vocal fold paralysis in 74.8 per cent of cases and bilateral vocal fold paralysis in 69.6 per cent of cases. Statistically significant improvements in patients were observed for voice, deglutition and decannulation (bilateral vocal fold paralysis). Meta-analysis of 10 reinnervation techniques was calculated for the maximum phonation time of 184 patients. CONCLUSION Reinnervation was shown to improve voice, swallowing and decannulation, but studies lacked control groups, limiting generalisability. Larger studies with controls are needed.
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Charous SJ, Hutz MJ, Bialek SE, Schumacher JK, Foecking EM. Muscle-Nerve-Nerve Grafting Improves Facial Reanimation in Rats Following Facial Nerve Injury. Front Neurol 2021; 12:723024. [PMID: 34956038 PMCID: PMC8692869 DOI: 10.3389/fneur.2021.723024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/05/2021] [Indexed: 11/18/2022] Open
Abstract
Nerve injury resulting in muscle paralysis from trauma or surgery is a major medical problem. Repair of such injuries with existing nerve grafting and reconstructive techniques often results in less than optimal outcomes. After previously demonstrating significant return of function using muscle-nerve-muscle (MNM) grafting in a rat facial nerve model, this study compares a variant of the technique, muscle-nerve-nerve (MNN) neurotization to MNM and interposition (IP) nerve grafting. Thirty male rats were randomized into four groups (1) control with no intervention, (2) repair with IP grafts, (3) MNM grafts and (4) MNN grafts. All groups had the buccal and marginal mandibular branches of the right facial nerve resected. Return of vibrissae movement, orientation, and snout symmetry was measured over 16 weeks. Functional recovery and muscle atrophy were assessed and quantified. All interventions resulted in significant improvement in vibrissae movement and orientation as compared to the control group (p < 0.05). The MNM and MNN groups had significantly less time to forward vibrissae movement as compared to controls (p < 0.05), and a large number of animals in the MNN group had coordinated vibrissae movement at 16 weeks. MNN and IP grafts retained significantly more muscle mass as compared to control (p < 0.05). Thus, MNN grafting is a promising adjuvant or alternative technique for reanimation for patients with unilateral peripheral nerve injury who are not candidates for primary neurorrhaphy.
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Affiliation(s)
- Steven J Charous
- Department of Otolaryngology-Head and Neck Surgery, Loyola University of Chicago, Maywood, IL, United States
| | - Michael J Hutz
- Department of Otolaryngology-Head and Neck Surgery, Loyola University of Chicago, Maywood, IL, United States
| | - Samantha E Bialek
- Research Service, Edward Hines Jr. VA Hospital, Hines, IL, United States
| | - Jane K Schumacher
- Stitch School of Medicine, Loyola University, Maywood, IL, United States
| | - Eileen M Foecking
- Department of Otolaryngology-Head and Neck Surgery, Loyola University of Chicago, Maywood, IL, United States.,Research Service, Edward Hines Jr. VA Hospital, Hines, IL, United States
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Telyshev D, Nesterenko I, Bochkov A, Malinina A, Markov A, Bordovsky S, Polunin G, Ananichuk A, Reshetov I. Functional Evaluation of Larynx Nerve Stimulator With EMG Acquisition Capability and Wireless Connectivity. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2021; 15:629-641. [PMID: 34232890 DOI: 10.1109/tbcas.2021.3094890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Recently, an electrical stimulation of the paralyzed muscle, as a potential therapy for restoring function of a denervated muscle system, has been debated as an innovative treatment in the management of patients with laryngeal paralysis. Numerous studies in acute and chronic animal models have demonstrated that electrical stimulation of the paralyzed posterior cricoarytenoideus muscle (PCA) offers an approach to induce vocal fold abduction and restore ventilation through the glottis. The study aims to test applicability of the controlled opening of the rima glottides via direct electrical stimulation of the posterior cricoarytenoideus muscle. We developed for this purpose a novel instrument system for the controlled larynx nerve stimulation. An acute experiment on the 4 years old pig showed effectiveness of the engineered stimulator. The controlled opening of rima glottidis of both posterior cricoarytenoid muscles and afterwards of both PCA muscle contraction were observed as a result of the electrical stimulation with the applied current in the range of 0.1-3 mA and pulse width of 1 ms and 10 ms. Performed research indicates a large potential of the novel nerve stimulator for the human larynx stimulation.
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Buczek E, Hicks M, Moroco A, Cottrill E. Neuroanatomy and Monitoring of the External Branch of the Superior Laryngeal Nerve. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00349-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chang YC, Vanz RL, Aurenção JC, Burgues T, Schanaider A. Unilateral frontalis muscle paralysis reanimated by contralateral frontalis muscle through sural nerve graft connecting the two muscles (muscle-nerve-muscle neurotization technique)-A case report. Microsurgery 2020; 41:181-185. [PMID: 33034911 DOI: 10.1002/micr.30665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 06/19/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022]
Abstract
Paralysis of the frontalis muscle is extremely difficult to reverse. The best treatment for facial paralysis reanimation which preserves spontaneity and muscle specificity is end-to-end neurorrhaphy through cross-face nerve grafting. However, it is rarely possible. Muscle-nerve-muscle (MNM) neurotization consists of an interposition of a nerve graft connecting the normal muscle to the denervated muscle. The axons of the muscle with intact innervation grow inside a neural graft towards the paralyzed muscle resulting in neurotization. The purpose of this report is to present a case of frontalis muscle paralysis reanimated by MNM neurotization. A 65-year-old female patient presented complete facial paralysis after temporomandibular joint surgery. Five months afterwards, the patient spontaneously recovered facial muscle movements except the frontalis muscle. Definitive paralysis of the frontalis muscle was diagnosed after 11 months, and MNM neurotization was chosen and performed. Three strings of sural nerve were placed in separated tunnels in the subcutaneous plane, through small skin incisions to connect the two bellies of frontalis muscle bilaterally, and then sutured into the muscle pocket of each side. The patient presented voluntary and synchronic contraction of the bilateral frontalis muscle, 4 months after neurotization. Electroneuromyography confirmed muscle contraction by contralateral stimulation. Despite its efficacy still being researched, it is a very promising technique for the reanimation of small muscles in facial paralysis.
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Affiliation(s)
- Yung Chia Chang
- Department of Microsurgery of Hospital dos, Servidores do Estado (HFSE), Rio de Janeiro, Brazil
| | - Ricardo Luiz Vanz
- Department of Microsurgery of Hospital dos, Servidores do Estado (HFSE), Rio de Janeiro, Brazil
| | - Juliana Calvet Aurenção
- Department of Microsurgery of Hospital dos, Servidores do Estado (HFSE), Rio de Janeiro, Brazil
| | | | - Alberto Schanaider
- Department of Surgery, School of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Effects of Voice Therapy on Laryngeal Motor Units During Phonation in Chronic Superior Laryngeal Nerve Paresis Dysphonia. J Voice 2018; 32:729-733. [DOI: 10.1016/j.jvoice.2017.08.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/28/2017] [Indexed: 11/22/2022]
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Foecking EM, Burgess BD, Fridrici ZC, Bialek SE, Low C, Charous SJ. Effects of the Number of Muscle-Nerve-Muscle Grafts on Rat Facial Nerve Functional Recovery. Ann Otol Rhinol Laryngol 2018; 127:791-797. [DOI: 10.1177/0003489418795980] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Facial nerve denervation can be devastating for patients. Primary neurorrhaphy and interposition (IP) nerve grafting are common reinnervation techniques. Muscle-nerve-muscle (MNM) grafting is a lesser known alternative. After previously demonstrating significant return of function using MNM grafting in a rat facial nerve model, the authors compare the use of multiple MNM nerve grafts with that of single MNM and IP nerve grafts. Methods: Thirty-six male rats were randomized into 4 groups: (1) repair with IP grafts, (2) 1 MNM graft, (3) 3 MNM grafts, and (4) control with no intervention. All groups had the lower zygomatic, buccal, and marginal mandibular branches of the right facial nerve removed. Return of movement and snout symmetry was measured over 16 weeks. Axonal regeneration and muscle atrophy were assessed and quantified. Results: All intervention groups had significantly improved movement and snout symmetry compared with control. Rats in the IP group had significantly increased axon density compared with those in the MNM groups but with smaller axonal diameter than control rats. No difference in axon density or diameter was observed between MNM groups. Use of 3 MNM grafts and IP grafts resulted in preservation of similar muscle mass compared with the control and 1-MNM groups. Conclusion: MNM grafting may be an alternative when other reanimation techniques are not possible. Level of Evidence: NA
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Affiliation(s)
- Eileen M. Foecking
- Department of Otolaryngology–Head and Neck Surgery, Loyola University of Chicago, Maywood, IL, USA
- Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Bridget D. Burgess
- Department of Otolaryngology–Head and Neck Surgery, Loyola University of Chicago, Maywood, IL, USA
| | - Zachary C. Fridrici
- Department of Otolaryngology–Head and Neck Surgery, Loyola University of Chicago, Maywood, IL, USA
| | | | - Christopher Low
- Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA
| | - Steven J. Charous
- Department of Otolaryngology–Head and Neck Surgery, Loyola University of Chicago, Maywood, IL, USA
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Lin RJ, Smith LJ, Munin MC, Sridharan S, Rosen CA. Innervation status in chronic vocal fold paralysis and implications for laryngeal reinnervation. Laryngoscope 2018; 128:1628-1633. [DOI: 10.1002/lary.27078] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 10/25/2017] [Accepted: 12/04/2017] [Indexed: 11/11/2022]
Affiliation(s)
- R. Jun Lin
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto, St. Michael's Hospital; Toronto Ontario Canada
| | - Libby J. Smith
- the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine; University of Pittsburgh
| | - Michael C. Munin
- the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine; University of Pittsburgh
- Department of Physical Medicine and Rehabilitation; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania U.S.A
| | - Shaum Sridharan
- the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine; University of Pittsburgh
| | - Clark A. Rosen
- the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine; University of Pittsburgh
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Potenza AS, Araujo Filho VJF, Cernea CR. Injury of the external branch of the superior laryngeal nerve in thyroid surgery. Gland Surg 2017; 6:552-562. [PMID: 29142848 DOI: 10.21037/gs.2017.06.15] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The external branch of the superior laryngeal nerve (EBSLN) innervates the cricothyroid muscle (CTM) to promote lengthening and thinning of the vocal fold, thus increasing voice pitch. The close relation with the superior thyroid vessels (STV) puts the EBSLN in risk every time the superior pole of the thyroid is dissected. It travels downward to innervate the CTM, lateral to the thyroid cartilage and to the inferior pharyngeal constrictor muscle (IPCM), being eventually covered by this muscle fibers as it approaches its entry point. During its descending course, the EBSLN curves and crosses the STV posteriorly. The lower this crossing occurs in the neck, the higher the risk of surgical damage to the nerve by transection, traction, entrapment, thermal damage or disrupted blood supply. The chances of surgical trauma are also increased by size and weight of the specimen, shorter neck length and non-white ethnicity. Voice changes following thyroid surgery are common and multifactorial. The actual rate of vocal impairment due to EBSLN injury is unclear, since changes to the everyday speaking voice can be minimal and laryngeal findings are usually subtle and controversial. CTM electroneuromyography (EMG) is the most accurate tool to diagnose abnormal EBSLN conductivity, but it is technically difficult and barely applicable in routine practice. Recommended approaches to prevent injury include: (I) individual distal ligature of the STV by the thyroid capsule; (II) visual identification of the nerve and its trajectory and (III) electrostimulation with either observation of CTM twitch or intraoperative nerve monitoring (IONM) via dedicated endotracheal tube electrodes. There is accumulating evidence that a combination of visual and standardized electrophysiological EBSLN identification with meticulous division of the STV improves preservation rates. IONM bears the additional benefits of prognostication, quantification and documentation of neural function once it allows intraoperative laryngeal EMG.
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Affiliation(s)
- Andre S Potenza
- Department of Surgery, Head and Neck Surgery Service of the Hospital das Clínicas, Faculty of Medicine of the University of Sao Paulo, Sao Paulo, Brazil
| | - Vergilius J F Araujo Filho
- Department of Surgery, Head and Neck Surgery Service of the Hospital das Clínicas, Faculty of Medicine of the University of Sao Paulo, Sao Paulo, Brazil
| | - Claudio R Cernea
- Department of Surgery, Head and Neck Surgery Service of the Hospital das Clínicas, Faculty of Medicine of the University of Sao Paulo, Sao Paulo, Brazil
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Zeng T, Zhang Z, Peng W, Zhang F, Shi BY, Chen F. Unilateral Laryngeal Pacing System and Its Functional Evaluation. Neural Plast 2017; 2017:8949165. [PMID: 28203464 PMCID: PMC5288527 DOI: 10.1155/2017/8949165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/25/2016] [Accepted: 12/27/2016] [Indexed: 11/18/2022] Open
Abstract
Goal. To establish a reliable instrumental system for synchronized reactivation of a unilaterally paralyzed vocal fold and evaluate its functional feasibility. Methods. Unilateral vocal fold paralysis model was induced by destruction of the left recurrent laryngeal nerve (RLN) in anesthetized dogs. With a micro controller-based electronic system, electromyography (EMG) signals from cricothyroid (CT) muscle on the ipsilateral side were recorded and used to trigger pacing of paralyzed vocalis muscles. The dynamic movement of vocal folds was continuously monitored using an endoscope, and the opening and closing of the glottis were quantified with customized imaging processing software. Results. The recorded video images showed that left side vocal fold was obviously paralyzed after destructing the RLN. Using the pacing system with feedback triggering EMG signals from the ipsilateral CT muscle, the paralyzed vocal fold was successfully reactivated, and its movement was shown to be synchronized with the healthy side. Significance. The developed unilateral laryngeal pacing system triggered by EMG from the ipsilateral side CT muscle could be successfully used in unilateral vocal fold paralysis with the advantage of avoiding disturbance to the healthy side muscles.
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Affiliation(s)
- Taiping Zeng
- State Key Laboratory of Robotics, Shenyang Institute of Automation, Chinese Academy of Sciences, Shenyang 110016, China
- Department of Biomedical Engineering, Southern University of Science & Technology, Shenzhen 518055, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zhiping Zhang
- The First Affiliated Hospital of the Medical College, Shihezi University, Shihezi, China
| | - Weiwei Peng
- Brain Function and Psychological Science Research Center, Shenzhen University, Shenzhen, China
| | - Fei Zhang
- Children's Hospital of Zhengzhou, Zhengzhou, China
| | - Baker Y. Shi
- Metokos LLC, P.O. Box 219244, Portland, OR 9221, USA
| | - Fangyi Chen
- Department of Biomedical Engineering, Southern University of Science & Technology, Shenzhen 518055, China
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Charous SJ, Hotaling JM, Burgess BD, Sappington JM, Park J, Turek G, Foecking EM. Muscle-Nerve-Muscle Grafting for Facial Reanimation in Rats. Ann Otol Rhinol Laryngol 2017; 126:261-267. [DOI: 10.1177/0003489416686587] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Facial paralysis is a devastating condition leaving patients with a myriad of aesthetic and functional consequences. Muscle-nerve-muscle (MNM) neurotization is a reinnervation technique that involves implanting an autogenous nerve graft as a conduit between an innervated “donor” muscle and a denervated “recipient” muscle. We investigated the use of MNM reinnervation, alone or in combination with electrical stimulation (ES) and testosterone propionate (TP) in comparison to nerve reanastomosis (RE), on functional recovery following rat facial nerve injury. Methods: Thirty-one male, Sprague-Dawley rats were assigned to groups: no graft (control), MNM grafting alone (MNM), MNM grafting with ES and TP (MNM+ES+TP), or RE. Harvested right facial nerve branches were used as the MNM graft. Functional recovery was assessed by behavioral observations and electromyographic recordings. Results: The MNM grafting improved muscle tone and vibrissae movement. The ES+TP treatment further enhanced muscle tone as well as reduced recovery time for coordinated movement in a manner that is comparable to those of RE. Electromyographic recordings demonstrated electrical conductance across all MNM grafts. Conclusion: These data have important implications for patients with unilateral paralysis from facial or laryngeal nerve injury, particularly those who are not candidates for nerve reanastomosis.
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Affiliation(s)
- Steven J. Charous
- Loyola University of Chicago, Department of Otolaryngology-Head and Neck Surgery, Maywood, Illinois, USA
| | - Jeffery M. Hotaling
- Loyola University of Chicago, Department of Otolaryngology-Head and Neck Surgery, Maywood, Illinois, USA
| | - Bridget D. Burgess
- Loyola University of Chicago, Department of Otolaryngology-Head and Neck Surgery, Maywood, Illinois, USA
| | - Joshua M. Sappington
- Loyola University of Chicago, Department of Otolaryngology-Head and Neck Surgery, Maywood, Illinois, USA
| | - James Park
- Loyola University of Chicago, Stritch School of Medicine, Maywood, Illinois, USA
| | - Grant Turek
- Loyola University of Chicago, Stritch School of Medicine, Maywood, Illinois, USA
| | - Eileen M. Foecking
- Loyola University of Chicago, Department of Otolaryngology-Head and Neck Surgery, Maywood, Illinois, USA
- Edward Hines Jr. VA Hospital, Hines, Illinois, USA
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Prospective validation study of Cernea classification for predicting EMG alterations of the external branch of the superior laryngeal nerve. Surg Today 2015; 46:785-91. [PMID: 26362419 DOI: 10.1007/s00595-015-1245-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022]
Abstract
PURPOSES Cernea classification is applied to describe the external branch of the superior laryngeal nerve (EBSLN). Using intraoperative neural monitoring we evaluated whether or not this classification is useful for predicting which EBSLN subtype has an increased risk of injury. METHODS An analysis of 400 EBSLN. The identification of EBSLN was achieved with both cricothyroid muscle twitch and the glottis evoked electromyography response. We defined S1 initial EBSLN stimulation at identification and S2 final nerve stimulation achieved in the most cranial aspect of the nerve exposed above the area of surgical dissection after superior artery ligation. RESULTS The mean S1 amplitude acquired was 259+/67 (180-421), 321 +/79 (192-391), 371 +/38 (200-551) μV, respectively, for type 1, 2A, 2B (p = 0.08). The S1 and S2 amplitudes were similar in type 1 (p = 0.3). The S1 and S2 determinations changed significantly in type 2A and 2B (p = 0.04 and 0.03). EBSLN which demonstrated a >25 % decreased amplitude in S2 increased significantly from Type 1 (4.9 %) to Type 2A (11.2 %) and 2B (18 %) (p = 0.01). None of type 1, 2.8 % type 2A and 3 % type 2B showed a loss of EBSLN conductivity. The latency determinations did not vary significantly for any parameter compared. CONCLUSIONS The Cernea classification was, therefore, found to predict the risk of EBSLN stress. We identified amplitude differences between S1 and S2 determinations in type 2A and 2B, thus confirming that surgical dissection in these subtypes is, therefore, extremely difficult to perform.
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Superior laryngeal nerve injury: effects, clinical findings, prognosis, and management options. Curr Opin Otolaryngol Head Neck Surg 2015; 22:439-43. [PMID: 25136863 DOI: 10.1097/moo.0000000000000097] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The superior laryngeal nerve (SLN) provides motor innervation to the cricothyroid muscle. However, the functions of this muscle and the anatomic variations of the nerve that supplies it are not fully understood. SLN paresis and paralysis (SLNp) is difficult to diagnose because of a lack of consistent laryngeal findings, and its effects on the voice likely go beyond simple pitch elevation control. RECENT FINDINGS Although SLNp has traditionally been thought to lead to voice pitch limitation, recent research findings reveal multiple roles for this nerve in voice and speech. Cricothyroid muscles are the primary controls of fundamental frequency of voice. SLNp can lead to significant contraction of pitch range, vocal fold vibratory phase asymmetry, and acoustic aperiodicity, thus leading to an overall poor vocal quality. In addition, cricothyroid muscles may also play a role in pitch lowering and shifting from voiced to unvoiced sounds during speech. SUMMARY Subtle signs, symptoms, and diagnostic findings associated with SLNp make this disorder difficult to characterize clinically. Lack of treatment methodologies to restore the dynamic action of the cricothyroid muscles poses difficulties in treating patients with this condition. A more thorough understanding of the effects of SLNp will improve diagnosis and treatment.
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Mangano A, Lianos GD, Boni L, Kim HY, Roukos DH, Dionigi G. Intraoperative neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy: the need for evidence-based data and perioperative technical/technological standardization. ScientificWorldJournal 2014; 2014:692365. [PMID: 25525624 PMCID: PMC4265369 DOI: 10.1155/2014/692365] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/26/2014] [Accepted: 10/28/2014] [Indexed: 11/17/2022] Open
Abstract
The external branch of the superior laryngeal nerve (EBSLN) is surgically relevant since its close anatomical proximity to the superior thyroid vessels. There is heterogeneity in the EBSLN anatomy and EBSLN damage produces changes in voice that are very heterogenous and difficult to diagnose. The reported prevalence of EBSLN injury widely ranges. EBSLN iatrogenic injury is considered the most commonly underestimated complication in endocrine surgery because vocal assessment underestimates such event and laryngoscopic postsurgical evaluation does not show standardized findings. In order to decrease the risk for EBSLN injury, multiple surgical approaches have been described so far. IONM provides multiple advantages in the EBSLN surgical approach. In this review, we discuss the current state of the art of the monitored approach to the EBSLN. In particular, we summarize, providing our additional remarks, the most relevant aspects of the standardized technique brilliantly described by the INMSG (International Neuromonitoring Study Group). In conclusion, in our opinion, there is currently the need for more prospective randomized trials investigating the electrophysiological and pathological aspects of the EBSLN for a better understanding of the role of IONM in the EBSLN surgery.
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Affiliation(s)
- Alberto Mangano
- 1st Department of General Surgery Ospedale di Circolo e Fondazione Macchi Varese, Department of Human Morphology and Surgical Sciences Endocrine Surgery Research Center, Insubria University Varese-Como, 21100 Varese, Italy
| | - Georgios D. Lianos
- Department of General Surgery, Ioannina University Hospital and Centre for Biosystems and Genomic Network Medicine Ioannina University, 45110 Ioannina, Greece
| | - Luigi Boni
- 1st Department of General Surgery Ospedale di Circolo e Fondazione Macchi Varese, Department of Human Morphology and Surgical Sciences Endocrine Surgery Research Center, Insubria University Varese-Como, 21100 Varese, Italy
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dimitrios H. Roukos
- Department of General Surgery, Ioannina University Hospital and Centre for Biosystems and Genomic Network Medicine Ioannina University, 45110 Ioannina, Greece
| | - Gianlorenzo Dionigi
- 1st Department of General Surgery Ospedale di Circolo e Fondazione Macchi Varese, Department of Human Morphology and Surgical Sciences Endocrine Surgery Research Center, Insubria University Varese-Como, 21100 Varese, Italy
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Barczyński M, Randolph GW, Cernea CR, Dralle H, Dionigi G, Alesina PF, Mihai R, Finck C, Lombardi D, Hartl DM, Miyauchi A, Serpell J, Snyder S, Volpi E, Woodson G, Kraimps JL, Hisham AN. External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement. Laryngoscope 2013; 123 Suppl 4:S1-14. [DOI: 10.1002/lary.24301] [Citation(s) in RCA: 228] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/12/2013] [Accepted: 06/12/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of General Surgery; Jagiellonian University Medical College; Kraków; Poland
| | | | - Claudio R. Cernea
- Department of Head and Neck Surgery; University of São Paulo Medical School; São Paulo; Brazil
| | - Henning Dralle
- Department of General, Visceral, and Vascular Surgery; Martin Luther University Halle-Wittenberg; Halle; Germany
| | - Gianlorenzo Dionigi
- Department of Surgical Sciences; Endocrine Surgery Research Center, University of Insubria; Varese-Como; Italy
| | - Piero F. Alesina
- Department of Surgery and Center for Minimally Invasive Surgery; Kliniken Essen-Mitte, Academic Teaching Hospital, University of Duisburg-Essen; Essen; Germany
| | - Radu Mihai
- Department of Endocrine Surgery; John Radcliffe Hospital; Oxford; United Kingdom
| | - Camille Finck
- Department of Otorhinolaryngology; University of Liège; Liège; Belgium
| | - Davide Lombardi
- Department of Otorhinolaryngology; University of Brescia; Brescia; Italy
| | - Dana M. Hartl
- Department of Head and Neck Oncology; Institute Gustave Roussy; Villejuif; France
| | | | - Jonathan Serpell
- Monash University Endocrine Surgery Unit; The Alfred Hospital; Melbourne; Victoria; Australia
| | - Samuel Snyder
- Department of Surgery; Texas A&M Health Science Center College of Medicine, Scott and White Clinic; Temple; Texas; U.S.A
| | - Erivelto Volpi
- Department of Surgery; Faculty of Medical Sciences-Santa Casa; São Paulo; Brazil
| | - Gayle Woodson
- Department of Surgery, Division of Otolaryngology; Southern Illinois University School of Medicine; Springfield; Illinois; U.S.A
| | - Jean Louis Kraimps
- Department of Endocrine Surgery; Poitiers University, Jean Bernard Hospital; Poitiers; France
| | - Abdullah N. Hisham
- Department of Breast and Endocrine Surgery; Putrajaya Hospital; Putrajaya; Malaysia
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Chandrasekhar SS, Randolph GW, Seidman MD, Rosenfeld RM, Angelos P, Barkmeier-Kraemer J, Benninger MS, Blumin JH, Dennis G, Hanks J, Haymart MR, Kloos RT, Seals B, Schreibstein JM, Thomas MA, Waddington C, Warren B, Robertson PJ. Clinical Practice Guideline. Otolaryngol Head Neck Surg 2013; 148:S1-37. [DOI: 10.1177/0194599813487301] [Citation(s) in RCA: 289] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective Thyroidectomy may be performed for clinical indications that include malignancy, benign nodules or cysts, suspicious findings on fine needle aspiration biopsy, dysphagia from cervical esophageal compression, or dyspnea from airway compression. About 1 in 10 patients experience temporary laryngeal nerve injury after surgery, with longer lasting voice problems in up to 1 in 25. Reduced quality of life after thyroid surgery is multifactorial and may include the need for lifelong medication, thyroid suppression, radioactive scanning/treatment, temporary and permanent hypoparathyroidism, temporary or permanent dysphonia postoperatively, and dysphagia. This clinical practice guideline provides evidence-based recommendations for management of the patient’s voice when undergoing thyroid surgery during the preoperative, intraoperative, and postoperative period. Purpose The purpose of this guideline is to optimize voice outcomes for adult patients aged 18 years or older after thyroid surgery. The target audience is any clinician involved in managing such patients, which includes but may not be limited to otolaryngologists, general surgeons, endocrinologists, internists, speech-language pathologists, family physicians and other primary care providers, anesthesiologists, nurses, and others who manage patients with thyroid/voice issues. The guideline applies to any setting in which clinicians may interact with patients before, during, or after thyroid surgery. Children under age 18 years are specifically excluded from the target population; however, the panel understands that many of the findings may be applicable to this population. Also excluded are patients undergoing concurrent laryngectomy. Although this guideline is limited to thyroidectomy, some of the recommendations may extrapolate to parathyroidectomy as well. Results The guideline development group made a strong recommendation that the surgeon should identify the recurrent laryngeal nerve(s) during thyroid surgery. The group made recommendations that the clinician or surgeon should (1) document assessment of the patient’s voice once a decision has been made to proceed with thyroid surgery; (2) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, if the patient’s voice is impaired and a decision has been made to proceed with thyroid surgery; (3) examine vocal fold mobility, or refer the patient to a clinician who can examine vocal fold mobility, once a decision has been made to proceed with thyroid surgery if the patient’s voice is normal and the patient has (a) thyroid cancer with suspected extrathyroidal extension, or (b) prior neck surgery that increases the risk of laryngeal nerve injury (carotid endarterectomy, anterior approach to the cervical spine, cervical esophagectomy, and prior thyroid or parathyroid surgery), or (c) both; (4) educate the patient about the potential impact of thyroid surgery on voice once a decision has been made to proceed with thyroid surgery; (5) inform the anesthesiologist of the results of abnormal preoperative laryngeal assessment in patients who have had laryngoscopy prior to thyroid surgery; (6) take steps to preserve the external branch of the surperior laryngeal nerve(s) when performing thyroid surgery; (7) document whether there has been a change in voice between 2 weeks and 2 months following thyroid surgery; (8) examine vocal fold mobility or refer the patient for examination of vocal fold mobility in patients with a change in voice following thyroid surgery; (9) refer a patient to an otolaryngologist when abnormal vocal fold mobility is identified after thyroid surgery; (10) counsel patients with voice change or abnormal vocal fold mobility after thyroid surgery on options for voice rehabilitation. The group made an option that the surgeon or his or her designee may monitor laryngeal electromyography during thyroid surgery. The group made no recommendation regarding the impact of a single intraoperative dose of intravenous corticosteroid on voice outcomes in patients undergoing thyroid surgery.
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Affiliation(s)
| | - Gregory W. Randolph
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Michael D. Seidman
- Department of Otolaryngology, Henry Ford Medical Center, West Bloomfield, Michigan, USA
| | - Richard M. Rosenfeld
- Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Peter Angelos
- University of Chicago Medical Center, Chicago, Illinois, USA
| | | | | | - Joel H. Blumin
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - John Hanks
- University of Virginia, School of Medicine, Charlottesville, Virginia, USA
| | - Megan R. Haymart
- Department of Internal Medicine, Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Brenda Seals
- Native American Cancer Research, Denver, Colorado, USA
| | - Jerry M. Schreibstein
- Ear, Nose and Throat Surgeons of Western New England LLC, Springfield, Massachusetts, USA
| | | | | | - Barbara Warren
- LGBT Health Services, Beth Israel Medical Center, New York, New York, USA
| | - Peter J. Robertson
- American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Systematic review of laryngeal reinnervation techniques. Otolaryngol Head Neck Surg 2010; 143:749-59. [DOI: 10.1016/j.otohns.2010.09.031] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Accepted: 09/17/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: To systematically review outcomes of reinnervation techniques for the management of unilateral vocal fold paralysis (UVFP). DATA SOURCES: Medline and Cochrane databases for English-language studies published between 1966 and 2009 on the surgical management of UVFP. REVIEW METHODS: Studies were excluded if they reported on bilateral vocal fold paralysis, used nonhuman subjects, or did not assess clinical outcomes. Outcomes of interest were visual analysis, acoustic analysis, perceptual analysis, and electromyography. RESULTS: Of 686 initial studies, 14 studies encompassing 329 patients were eligible for analysis. All studies had a case-series design. Of reported patients, 60.2 percent were men, with mean age of 51 years (range, 12-79 years). The most common reinnervation technique was ansa cervicalis-to-recurrent laryngeal nerve (RLN), which was most commonly performed after thyroidectomy (43.5%). Other techniques with reportable outcomes included primary RLN anastomosis, ansa-to-RLN combined with cricothyroid muscle-nerve-muscle pedicle, ansa-to-thyroarytenoid neural implantation, ansa-to-thyroarytenoid neuromuscular pedicle, and hypoglossal-to-RLN. Median postsurgical follow-up was 12 months, and mean time to first signs of reinnervation was 4.5 months (SD 2.9 months). Visual analysis of glottic gap showed the greatest mean improvement with ansa-to-RLN, from 2.25 (SD 0.886) to 0.75 (SD 0.886) mm ( P < 0.01). Acoustic analysis showed greatest improvement with neural implantation, with a change in mean phonation time from seven (SD 1.22) to 16 (SD 5.52) seconds ( P < 0.01). Perceptual analysis and electromyography demonstrated improvement in all studies. CONCLUSION: Reinnervation is effective in the management of UVFP, although the specific method may be dictated by anatomical limitations. Prospective studies utilizing uniform and consistent outcome parameters are necessary.
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Wright SK, Lobe T. Transaxillary totally endoscopic robot-assisted ansa cervicalis to recurrent laryngeal nerve reinnervation for repair of unilateral vocal fold paralysis. J Laparoendosc Adv Surg Tech A 2009; 19 Suppl 1:S203-6. [PMID: 19260797 DOI: 10.1089/lap.2008.0197.supp] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pediatric unilateral vocal-fold paralysis represents a source of significant morbidity, for which treatment options are quite limited. Conventional management strategies suitable for adults are not appropriate for the developing larynx. In this study, we report the first experience with minimally invasive laryngeal reinnervation. While open techniques for pediatric recurrent laryngeal nerve reinnervation have been performed, these require large, visible incisions, which limit the appeal of this technique. The transaxillary endoscopic approach to the neck significantly reduces pain and recovery time from cervical surgery. In this study, we report the feasibility of transaxillary totally endoscopic robot-assisted laryngeal reinnervation for unilateral vocal-fold paralysis. Operative time was less than 3 hours, and patients were discharged the day of surgery. No postoperative narcotics were required. Initial results are favorable.
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Affiliation(s)
- Simon K Wright
- ENT Clinic of Iowa, Blank Children's Hospital, West Des Moines, Iowa 50266, USA.
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Smith ME, Roy N, Stoddard K. Ansa-RLN reinnervation for unilateral vocal fold paralysis in adolescents and young adults. Int J Pediatr Otorhinolaryngol 2008; 72:1311-6. [PMID: 18586331 DOI: 10.1016/j.ijporl.2008.05.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2008] [Revised: 05/09/2008] [Accepted: 05/09/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE/HYPOTHESIS To assess the outcomes of management of unilateral vocal fold paralysis by ansa-RLN reinnervation in a series of patients ages 12-21. STUDY DESIGN Clinical outcomes study. METHODS Six consecutive adolescents and young adults (ages 12-21 years) seeking treatment for unilateral vocal fold paralysis and glottal incompetence underwent ansa-RLN neurorraphy. Pre- and post-operative voice recordings acquired at least 1 year following surgery were submitted to acoustic and perceptual analysis. Patient-based measures were also taken. RESULTS Mean perceptual visual analogue scale rating of dysphonia severity (0mm=profoundly abnormal voice, 100mm=completely normal voice) improved from 50mm pre-operatively to 82mm post-operatively. Mean maximum phonation time improved from 6.5s to 13.2s. Pitch and dynamic range were also observed to improve. Global self-ratings of voice function (0-100%) increased from 31.2% to 81.6% of normal. CONCLUSIONS Ansa-RLN reinnervation is an effective treatment option for adolescents and young adults with unilateral vocal fold paralysis. The procedure has the potential to improve vocal function substantially, especially in those with isolated paralysis of the recurrent laryngeal nerve. The procedure alleviates the disadvantages associated with other surgical options for this age group.
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Affiliation(s)
- Marshall E Smith
- Division of Otolaryngology, Head and Neck Surgery, Primary Children's Medical Center, University of Utah School of Medicine, The University of Utah, 3C-120 SOM, 50N. Medical Dr., Salt Lake City, UT 84132, United States.
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22
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Intrinsic Laryngeal Muscle Reinnervation Using the Muscle-Nerve-Muscle Technique. Ann Otol Rhinol Laryngol 2008; 117:382-8. [DOI: 10.1177/000348940811700509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: This study was performed to investigate the muscle-nerve-muscle reinnervation technique in the larynx, in which a nerve conduit implanted into an innervated muscle conducts axonal sprouting into a denervated muscle while maintaining function of the donor muscle. Methods: In this study, the muscle-nerve-muscle technique was used to direct superior laryngeal nerve axons to reinnervate intrinsic laryngeal muscles by implanting the recurrent laryngeal nerve stump into the cricothyroid muscle in 8 dogs. In 4 of the dogs, the recurrent laryngeal nerve trunk to the adductor muscles was divided so that all axonal sprouting was directed to the posterior cricoarytenoid muscle. Six-month electromyography data were obtained from 6 of the 8 dogs. Results: All 6 dogs showed evidence of successful reinnervation of the thyroarytenoid or posterior cricoarytenoid muscles with action potentials that corresponded to spontaneous respiratory efforts, while the donor cricothyroid muscles retained their phasic contraction. These responses were obliterated when the recurrent laryngeal nerve conduit was divided. Histologic examination of the intrinsic laryngeal muscles demonstrated successful reinnervation. Conclusions: The results confirm that intrinsic laryngeal muscles may be successfully reinnervated by the superior laryngeal nerve with the muscle-nerve-muscle technique, without sacrifice of function of the cricothyroid muscle. This method offers an alternative source of appropriately firing axons for laryngeal reinnervation procedures.
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Abstract
Numerous neurologic diseases affect voice production either through direct effects on the larynx or by affecting muscles involved with support or resonation of the voice. Voice changes can be the initial presenting symptoms of neurodegenerative disorders, especially in patients who have increased awareness of their vocal quality. Some patients present to the otolaryngologist before the neurologist. The otolaryngologist must have an understanding and familiarity with laryngeal manifestations of neurodegenerative diseases to make the appropriate diagnosis in a timely fashion. Moreover, the otolaryngologist can play a significant role in the care of patients who have neurodegenerative disease. Video procedures for neurolaryngologic evaluation accompany this content online.
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Affiliation(s)
- Adam D Rubin
- Lakeshore Professional Voice Center, Lakeshore Ear, Nose and Throat Center, 21000 E. Twelve Mile Road, Suite 111, Saint Clair Shores, MI 48081, USA.
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Katada A, Nonaka S, Adachi M, Kunibe I, Arakawa T, Imada M, Hayashi T, Zealear DL, Harabuchi Y. Functional electrical stimulation of laryngeal adductor muscle restores mobility of vocal fold and improves voice sounds in cats with unilateral laryngeal paralysis. Neurosci Res 2004; 50:153-9. [PMID: 15380322 DOI: 10.1016/j.neures.2004.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2004] [Accepted: 06/22/2004] [Indexed: 10/26/2022]
Abstract
Functional electrical stimulation (FES) has been proposed as a potential treatment for restoring motor functions of denervated motor systems. We investigated whether FES of paralyzed laryngeal adductor muscles could restore adduction to the vocal folds. In addition, we studied the effect of stimulated vocal fold adduction on the intensity and overall quality of voice production. We recorded movement of the vocal fold, electromyographic activity of muscles recruited for vocalization, and sound production in unanesthetized decerebrate cats during FES of the paralyzed thyroarytenoid (TA) muscle. FES of the paralyzed TA muscle induced adduction of the vocal fold. Appropriate stimulus parameters for induction was 1.5-3.0 mA intensity pulses delivered at a frequency of 30-50 pulses per second (pps). FES of the paralyzed TA muscle prolonged phonation time and increased intensity of voice sounds during vocalization induced by electrical stimulation (0.2 ms, 20-50 microA, 50 pps) of the periaqueductal gray (PAG). The quality of voice sounds evaluated by sound spectrography was shown to improve during vocalization with FES. We conclude that FES of the paralyzed laryngeal adductor muscle was effective in restoring adduction of the vocal fold and improving voice sounds impaired by unilateral laryngeal paralysis.
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Affiliation(s)
- Akihiro Katada
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical College, Midorigaoka Higashi 2-1-1-1, Asahikawa 078-8510, Japan.
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26
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Abstract
Laryngeal reinnervation refers to any of a number of surgical procedures intended to restore neural connections to the larynx, which have usually been lost from some type of trauma (eg, surgical). The nerve function(s) to be restored may be those of the recurrent laryngeal nerve or its subdivisions, those of the superior laryngeal nerve, or both, and they may be motor or sensory. Several different donor nerves are available and have been described. The technique used may be direct end-to-end anastomosis (neurorrhaphy), direct implantation of a nerve ending into a muscle, the nerve-muscle pedicle technique, or muscle-nerve-muscle methods. These nerves and techniques may be combined in many ways. A number of new techniques have been reported in animal studies; however, the animal studies do not always predict the results of analogous surgeries in human patients. The historical and current perspectives on these techniques are discussed in this article.
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Affiliation(s)
- Randal C Paniello
- Department of Otolaryngology, Washington University School of Medicine, 660 South Euclid, Campus Box 8115, St. Louis, MO 63110, USA.
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