Complementary Reinnervation in Unilateral Vocal Fold Paralysis

Abstract

Objectives

To achieve glottal gap closure in unilateral vocal fold paralysis (UVFP) through complementary ansa cervicalis nerve muscle pedicle laryngeal reinnervation (ANMP-LR).

Introduction

ANMP-LR is easy to learn and does not require recurrent laryngeal nerve (RLN) transection.

Materials and Methods

Twelve patients with unilateral vocal fold paralysis (UVFP) were included, who received ANMP-LR and could be followed up for at least 6–24 months. At baseline, after 3–6 (T1), 12 (T2) and 24 months (T3), Voice Handicap Index (VHI), perceived roughness (R) and breathiness (B), sound pressure level (SPLmax), maximum phonation time (MPT), Dysphonia Severity Index (DSI) and glottal gap (GG) were recorded.

Results

R and B were significantly reduced at T1, MPT and SPLmax increased significantly up to T1 (MPT to 15.8 s; SPLmax to 91.5 dB). Similarly, VHI dropped significantly and the residual glottal gap (GG) was significantly reduced between T0 and T1. All outcomes remained stable until T3. There was a non-significant tendency to further improvement until T3 in SPLmax and GG.

Discussion

The T1–T3 outcomes of the complementary ANMP-LR are comparable with the standard LR and also with thyroplasty. As with all LR techniques, younger patients and those with shorter paralysis benefit more. Patients with evidence of unfavorable laryngeal synkinesis are more likely to benefit from a standard LR with RLN transection.

Conclusions

Younger patients with insufficient synkinetic reinnervation and persisting or progressive glottis closure insufficiency in UVFP benefit from early reinnervation. When the easy-to-learn ANMP technique is used, any partial rehabilitation that has already been achieved or any remaining chance of spontaneous reinnervation via the RLN is not compromised.

Level of Evidence: 3