1
|
Lammers AR, Abid S, Ding P, German RZ. Effects of Superior Laryngeal Nerve Lesion on Kinematics of Swallowing and Airway Protection in an Infant Pig Model. Dysphagia 2020; 35:907-917. [PMID: 32140904 DOI: 10.1007/s00455-020-10100-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
The superior laryngeal nerve provides detailed sensory information from the mucosal surfaces of laryngeal structures superior to the vocal folds, including the valleculae. Injury to this nerve results in airway penetration and aspiration. Furthermore, such injuries might have an impact on the function of multiple structures involved in intraoral transport and swallowing due to connections within the brainstem. We sought to determine the effects of a surgical lesion of the superior laryngeal nerve on kinematics of the tongue, hyoid, and epiglottis during swallowing. We implanted radio-opaque markers into five infant pigs under anesthesia. Then we fed milk mixed with contrast agent to the pigs while they were recorded via video fluoroscopy, before and after a surgery to transect the superior laryngeal nerve. We digitized and rated airway protection in 177 swallows. We found that in most animals, swallow duration was shorter after nerve lesion. The hyoid also traveled a shorter distance after lesion. Frequently, individuals reacted differently to the same nerve lesion. We suggest that these differences are due to individual differences in neurological connections. When comparing hyoid kinematics between swallows with successful or failed airway protection, we found more consistency among individuals. This indicates that protecting the airway requires specific sets of kinematic events to occur, regardless of the neurological differences among individuals.
Collapse
Affiliation(s)
- Andrew R Lammers
- School of Health Sciences, Cleveland State University, 2121 Euclid Ave, Cleveland, OH, 44115, USA.
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA.
| | - Saja Abid
- School of Health Sciences, Cleveland State University, 2121 Euclid Ave, Cleveland, OH, 44115, USA
| | - Peng Ding
- Johns Hopkins Medicine International, 601 N. Caroline Street Suite 1080, Baltimore, MD, 21287, USA
| | - Rebecca Z German
- Department of Anatomy and Neurobiology, Northeast Ohio Medical University, Rootstown, OH, 44272, USA
| |
Collapse
|
2
|
Mok A, Allen J, Haney MM, Deninger I, Ballenger B, Caywood V, Osman KL, Zitsch B, Hopewell BL, Thiessen A, Szewczyk M, Ohlhausen D, Newberry CI, Leary E, Lever TE. A Surgical Mouse Model for Advancing Laryngeal Nerve Regeneration Strategies. Dysphagia 2019; 35:419-437. [PMID: 31388736 DOI: 10.1007/s00455-019-10045-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/06/2019] [Accepted: 07/31/2019] [Indexed: 01/16/2023]
Abstract
Iatrogenic recurrent laryngeal nerve (RLN) injury is a morbid complication of anterior neck surgical procedures. Existing treatments are predominantly symptomatic, ranging from behavioral therapy to a variety of surgical approaches. Though laryngeal reinnervation strategies often provide muscle tone to the paralyzed vocal fold (VF), which may improve outcomes, there is no clinical intervention that reliably restores true physiologic VF movement. Moreover, existing interventions neglect the full cascade of molecular events that affect the entire neuromuscular pathway after RLN injury, including the intrinsic laryngeal muscles, synaptic connections within the central nervous system, and laryngeal nerve anastomoses. Systematic investigations of this pathway are essential to develop better RLN regenerative strategies. Our aim was to develop a translational mouse model for this purpose, which will permit longitudinal investigations of the pathophysiology of iatrogenic RLN injury and potential therapeutic interventions. C57BL/6J mice were divided into four surgical transection groups (unilateral RLN, n = 10; bilateral RLN, n = 2; unilateral SLN, n = 10; bilateral SLN, n = 10) and a sham surgical group (n = 10). Miniaturized transoral laryngoscopy was used to assess VF mobility over time, and swallowing was assessed using serial videofluoroscopy. Histological assays were conducted 3 months post-surgery for anatomical investigation of the larynx and laryngeal nerves. Eight additional mice underwent unilateral RLN crush injury, half of which received intraoperative vagal nerve stimulation (iVNS). These 8 mice underwent weekly transoral laryngoscopy to investigate VF recovery patterns. Unilateral RLN injury resulted in chronic VF immobility but only acute dysphagia. Bilateral RLN injury caused intraoperative asphyxiation and death. VF mobility was unaffected by SLN transection (unilateral or bilateral), and dysphagia (transient) was evident only after bilateral SLN transection. The sham surgery group retained normal VF mobility and swallow function. Mice that underwent RLN crush injury and iVNS treatment demonstrated accelerated and improved VF recovery. We successfully developed a mouse model of iatrogenic RLN injury with impaired VF mobility and swallowing function that can serve as a clinically relevant platform to develop translational neuroregenerative strategies for RLN injury.
Collapse
Affiliation(s)
- Alexis Mok
- Department of Communication Science and Disorders, University of Missouri School of Health Professions, Columbia, MO, USA
| | - Jakob Allen
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Megan M Haney
- Department of Veterinary Pathobiology, University of Missouri College of Veterinary Medicine, Columbia, MO, USA
| | - Ian Deninger
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Brayton Ballenger
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Victoria Caywood
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Kate L Osman
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Bradford Zitsch
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Bridget L Hopewell
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Aaron Thiessen
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Marlena Szewczyk
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Daniel Ohlhausen
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | | | - Emily Leary
- Department of Orthopedic Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Teresa E Lever
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA. .,One Hospital Dr. MA314, Columbia, MO, 65212, USA.
| |
Collapse
|
3
|
Halum SL, Bijangi-Vishehsaraei K, Saadatzadeh MR, McRae BR. Differences in Laryngeal Neurotrophic Factor Gene Expression after Recurrent Laryngeal Nerve and Vagus Nerve Injuries. Ann Otol Rhinol Laryngol 2019. [DOI: 10.1177/000348941312201009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stacey L. Halum
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - M. Reza Saadatzadeh
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Bryan R. McRae
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|
4
|
Gazzaz M, Saini J, Pagliardini S, Tsui B, Jeffery C, El-Hakim H. Comparison of inhaled versus intravenous anesthesia for laryngoscopy and laryngeal electromyography in a rat model. J Otolaryngol Head Neck Surg 2018; 47:64. [PMID: 30342558 PMCID: PMC6196000 DOI: 10.1186/s40463-018-0312-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 10/05/2018] [Indexed: 12/26/2022] Open
Abstract
Background Propofol and remifentanil intravenous combination is one popular form of total intravenous anesthesia (TIVA) in mainstream clinical practice, but it has rarely been applied to a rat model for laryngoscopy and laryngeal electromyography (LEMG). Our objective was to establish a safe and reproducible general anesthetic protocol for laryngoscopy and endoscopic LEMG in a rat model. Our hypothesis is that TIVA allows a minimally morbid, and feasible laryngoscopy and LEMG. Methods Sprague Dawley rats were subjected to either inhalational anesthesia (IA) (isoflurane) or TIVA (propofol and remifentanil) and underwent laryngoscopy and LEMG. The primary outcome was a complete minimally interrupted rigid laryngoscopy and obtaining reproducible motor unit potentials from the posterior cricoarytenoid muscles. The secondary outcome was morbidity and mortality. Results Seventeen out of twenty-two rats underwent both TIVA and IA. Only two underwent IA only. All nineteen rats that underwent IA had a successful experiment. Seventeen rats underwent TIVA, however, only nine completed a successful experiment due to difficulty achieving a surgical plane, and respiratory events. Upon comparing the success of the two anaesthetic regimens, IA was superior to TIVA (P = 0.0008). There was no statistical difference between the amplitudes (p = 0.1985) or motor units burst duration (p = 0.82605) of both methods. Three mortalities were encountered, one of which was due to lidocaine toxicity and two were during anesthetic induction. Respiratory related morbidity was encountered in two rats, all seen with TIVA. Conclusions TIVA is not an ideal anesthetic regimen for laryngeal endoscopy and LEMG in rat models. Contrary to our hypothesis, IA did not affect the quality of the LEMG and allowed a seamless rigid endoscopy. Electronic supplementary material The online version of this article (10.1186/s40463-018-0312-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- M Gazzaz
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, 2C3.57 Walter MacKenzie Centre, Edmonton, AB, T6G 2R7, Canada.
| | - J Saini
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada.,Women and Children Research Institute, University of Alberta, Edmonton, AB, Canada
| | - S Pagliardini
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada.,Women and Children Research Institute, University of Alberta, Edmonton, AB, Canada.,Department of Physiology, University of Alberta, Edmonton, AB, Canada
| | - B Tsui
- Stanford University Pediatric Regional Anesthesia, Stanford University, Stanford, California, USA
| | - C Jeffery
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, 2C3.57 Walter MacKenzie Centre, Edmonton, AB, T6G 2R7, Canada
| | - H El-Hakim
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, 2C3.57 Walter MacKenzie Centre, Edmonton, AB, T6G 2R7, Canada
| |
Collapse
|
5
|
Rosko AJ, Kupfer RA, Oh SS, Haring CT, Feldman EL, Hogikyan ND. Immunohistologic analysis of spontaneous recurrent laryngeal nerve reinnervation in a rat model. Laryngoscope 2017; 128:E117-E122. [DOI: 10.1002/lary.27004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 01/29/2023]
Affiliation(s)
- Andrew J. Rosko
- Department of Otolaryngology-Head and Neck Surgery; University of Michigan Health Center; Ann Arbor Michigan U.S.A
| | - Robbi A. Kupfer
- Department of Otolaryngology-Head and Neck Surgery; University of Michigan Health Center; Ann Arbor Michigan U.S.A
| | - Sang S. Oh
- Department of Neurology; University of Michigan Medical School; Ann Arbor Michigan U.S.A
| | - Catherine T. Haring
- Department of Otolaryngology-Head and Neck Surgery; University of Michigan Health Center; Ann Arbor Michigan U.S.A
| | - Eva L. Feldman
- Department of Neurology; University of Michigan Medical School; Ann Arbor Michigan U.S.A
| | - Norman D. Hogikyan
- Department of Otolaryngology-Head and Neck Surgery; University of Michigan Health Center; Ann Arbor Michigan U.S.A
| |
Collapse
|
6
|
Kupfer RA, Old MO, Oh SS, Feldman EL, Hogikyan ND. Spontaneous laryngeal reinnervation following chronic recurrent laryngeal nerve injury. Laryngoscope 2013; 123:2216-27. [PMID: 23817931 DOI: 10.1002/lary.24049] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 12/21/2012] [Accepted: 01/17/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To enhance understanding of spontaneous laryngeal muscle reinnervation following severe recurrent laryngeal nerve injury by testing the hypotheses that 1) nerve fibers responsible for thyroarytenoid muscle reinnervation can originate from multiple sources and 2) superior laryngeal nerve is a source of reinnervation. STUDY DESIGN Prospective, controlled, animal model. METHODS A combination of retrograde neuronal labeling techniques, immunohistochemistry, electromyography, and sequential observations of vocal fold mobility were employed in rat model of chronic recurrent laryngeal nerve injury. The current study details an initial set of experiments in sham surgical and denervated group animals and a subsequent set of experiments in a denervated group. RESULTS At 3 months after recurrent laryngeal nerve resection, retrograde brainstem neuronal labeling identified cells in the characteristic superior laryngeal nerve cell body location as well as cells in a novel caudal location. Regrowth of neuron fibers across the site of previous recurrent laryngeal nerve resection was seen in 87% of examined animals in the denervated group. Electromyographic data support innervation by both the superior and recurrent laryngeal nerves following chronic recurrent laryngeal nerve injury. CONCLUSIONS Following chronic recurrent laryngeal nerve injury in the rat, laryngeal innervation is demonstrated through the superior laryngeal nerve from cells both within and outside of the normal cluster of cells that supply the superior laryngeal nerve. The recurrent laryngeal nerve regenerates across a surgically created gap, but functional significance of regenerated nerve fibers is unclear.
Collapse
Affiliation(s)
- Robbi A Kupfer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | | | | | | | | |
Collapse
|
7
|
Pitman MJ, Berzofsky C, Alli O, Sharma S. Recurrent Laryngeal Nerve Transection and Anastomosis: Rat Laryngeal Motoneuron Survival and Effect of the Anastomosis Site. Ann Otol Rhinol Laryngol 2013; 122:283-7. [DOI: 10.1177/000348941312200412] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|