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Neurolaryngology pp 185–200Cite as

Surgical Reinnervation

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Abstract

Laryngeal reinnervation can be performed in the treatment of both unilateral and bilateral vocal cord palsy. Here we discuss the development, technical steps and clinical outcomes of these procedures.

In unilateral palsy, the aim of reinnervation is to increase tonicity of the hemilarynx. This is achieved by a straight-forward anastomosis of the recurrent laryngeal nerve to a branch of the ansa hypoglossi. This non-selective reinnervation acts to rebalance the laryngeal muscles, preventing muscular atrophy, and giving good long-term voice results.

In bilateral paralysis, the vocal cords are usually in a paramedian position. This results in inspiratory dyspnea. However, phonation is satisfactorily preserved in most cases.

Classical modes of treatment for bilateral vocal fold paralysis are aimed at enlarging the glottis which can result in variable hoarseness and inadequate protective closure. Laryngeal reinnervation can theoretically solve these problems. The posterior cricoarytenoid muscles are responsible for abduction of the vocal folds and thus are the main target of selective reinnervation.

The initial technique using a nerve muscle pedicle of a branch of the hypoglossal was disappointing with poor visible abduction. This has now been superseded by new techniques using phrenic nerve roots, anastomosed to the posterior cricoarytenoid branches of the recurrent laryngeal nerves, or moreover, implanted into both posterior cricoarytenoid muscles to induce neurotisation. Adductor muscle reinnervation can also be performed to improve closure of the larynx and avoid inappropriate synkinetic reinnervation.

Using these techniques, dyspnea is relieved in three out of four cases, without degradation of the voice. Bilateral active abduction on inspiration is observed in approximately one half of cases where there is no previous intralaryngeal scar.

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Authors and Affiliations

  1. Otorhinolaryngology, Head and Neck Surgery, University Hospital of Rouen, 1 rue de Germont, Rouen, Normandy, 76000, France

    Jean-Paul Marie

  2. Otolaryngology, Poole Hospital NHS Trust, Longfleet Road, Poole, Dorset, BH15 2 JB, UK

    Kate Heathcote

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  1. Jean-Paul Marie
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Correspondence to Jean-Paul Marie .

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  1. Department of Otorhinolaryngology/Head and Neck Surgery, Clinical Centre Stuttgart, Stuttgart, Germany

    Christian Sittel

  2. Department of Otorhinolaryngology and Institute of Phoniatry and Pedaudiology, Jena University Hospital, Jena, Germany

    Orlando Guntinas-Lichius

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Marie, JP., Heathcote, K. (2018). Surgical Reinnervation. In: Sittel, C., Guntinas-Lichius, O. (eds) Neurolaryngology. Springer, Cham. https://doi.org/10.1007/978-3-319-61724-4_15

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  • DOI: https://doi.org/10.1007/978-3-319-61724-4_15

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