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Nerve Reconstruction

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Surgery of Larynx and Trachea

Abstract

Trunk-to-trunk anastomosis of a recurrent laryngeal nerve (RLN) does not allow recovery of vocal cord mobility. Vocal cord mobility is not necessary to achieve good voice results. Nonselective reinnervation is the optimal treatment of unilateral RLN lesion. It can be performed at the time of the injury, or it can be delayed. Dissection of the distal portion of the RLN is always possible by the retrograde intralaryngeal approach. Ansa hypoglossi- to-RLN anastomosis is the optimal technique for unilateral vocal cord paralysis. Nerve transfers have to be long enough to follow the laryngeal movements during swal­lowing. Superior laryngeal nerve (SLN) lesions can be sutured with good recovery of laryngeal sen­sation. In bilateral RLN lesion, with vocal cord in adductory position, treatments must respect the vocal cord integrity. New techniques of bilateral motor selective reinnervation of the larynx should be considered only in cases when the arytenoids remain passively mobile. Phrenic nerve is the optimal nerve supply for posterior cricoarytenoid muscle reinnervation. Preservation of some of its roots can spare some diaphragm innervation and function.

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Authors and Affiliations

  1. Service d’ORL & Chirurgie Cervico faciale, Hopital Ch Nicolle, CHU Rouen, F-76031, France

    Jean-Paul Marie

  2. Laboratoire de Chirurgie Expérimentale UPRES EA 3830 GRHV, IFRMP 23, Université de Rouen, Rouen, France

    Jean-Paul Marie

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Correspondence to Jean-Paul Marie .

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  1. Mont-Godinne, Univ. Hospital of Louvain at, Yvoir, 5530, Belgium

    Marc Remacle

  2. Hals-Nasen-Ohren Abteilung, Landeskrankenhaus Klagenfurt, St. Veiter Str. 47, Klagenfurt, 9026, Austria

    Hans Edmund Eckel

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Marie, JP. (2009). Nerve Reconstruction. In: Remacle, M., Eckel, H. (eds) Surgery of Larynx and Trachea. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-79136-2_24

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  • DOI: https://doi.org/10.1007/978-3-540-79136-2_24

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