Bilateral selective laryngeal reinnervation in patients with bilateral vocal cord palsy.

IF 2.1 4区 医学 Q2 OTORHINOLARYNGOLOGY Acta Otorhinolaryngologica Italica Pub Date : 2023-06-01 DOI:10.14639/0392-100X-N2395
Roberto Puxeddu, Valeria Marrosu, Marta Filauro, Cinzia Mariani, Giampiero Parrinello, Kate Heathcote, Clara Gerosa, Melania Tatti, Stefano Manca di Villahermosa, Francesco Mora, Giorgio Peretti, Filippo Carta
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Abstract

Objective: Bilateral selective reinnervation of the larynx aims to restore both vocal cord tone and abductor movements in patients with bilateral vocal cord palsy.

Methods: Four females and one male treated by bilateral selective reinnervation of the larynx were included in the present study. In all cases, both posterior cricoarytenoid muscles were reinnervated using the C3 right phrenic nerve root through the great auricular nerve graft, while adductor muscle tone was bilaterally restored using the thyrohyoid branches of the hypoglossal nerve through transverse cervical nerve grafts.

Results: After a minimum follow-up of 48 months, all patients were successfully tracheostomy free and had recovered normal swallowing. At laryngoscopy, the first patient recovered a left unilateral partial abductor movement, the second had complete bilateral abductor movements, the third did not show improvements of abductor movements, but symptomatology was improved, the fourth recovered partial bilateral abductor movements and the fifth case did not show improvements and needed posterior cordotomy.

Conclusions: Bilateral selective laryngeal reinnervation, although a complex surgical procedure, offers a more physiologic recovery in the treatment of bilateral vocal fold paralysis. Selection criteria still needs to be precisely defined to avoid unexpected failures.

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双侧声带麻痹患者的双侧选择性喉神经再植。
目的:双侧选择性喉神经重建术旨在恢复双侧声带麻痹患者的声带张力和外展肌运动。方法:采用双侧选择性喉部再神经植入术治疗4例女性,1例男性。在所有病例中,通过耳大神经移植使用C3右膈神经根对双侧环杓后肌进行再神经支配,同时通过颈横神经移植使用舌下神经甲状舌骨支修复双侧内收肌张力。结果:随访48个月后,所有患者均成功脱离气管切开术,并恢复正常吞咽。喉镜检查时,第1例患者恢复了左单侧部分外展肌运动,第2例患者完全恢复了双侧外展肌运动,第3例患者的外展肌运动没有改善,但症状有所改善,第4例患者恢复了双侧部分外展肌运动,第5例患者没有改善,需要进行后声带切开术。结论:双侧选择性喉神经移植虽然是一个复杂的手术过程,但在双侧声带麻痹的治疗中提供了更多的生理恢复。仍然需要精确地定义选择标准,以避免意外的失败。
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来源期刊
Acta Otorhinolaryngologica Italica
Acta Otorhinolaryngologica Italica OTORHINOLARYNGOLOGY-
CiteScore
3.40
自引率
10.00%
发文量
97
审稿时长
6-12 weeks
期刊介绍: Acta Otorhinolaryngologica Italica first appeared as “Annali di Laringologia Otologia e Faringologia” and was founded in 1901 by Giulio Masini. It is the official publication of the Italian Hospital Otology Association (A.O.O.I.) and, since 1976, also of the Società Italiana di Otorinolaringoiatria e Chirurgia Cervico-Facciale (S.I.O.Ch.C.-F.). The journal publishes original articles (clinical trials, cohort studies, case-control studies, cross-sectional surveys, and diagnostic test assessments) of interest in the field of otorhinolaryngology as well as clinical techniques and technology (a short report of unique or original methods for surgical techniques, medical management or new devices or technology), editorials (including editorial guests – special contribution) and letters to the Editor-in-Chief. Articles concerning science investigations and well prepared systematic reviews (including meta-analyses) on themes related to basic science, clinical otorhinolaryngology and head and neck surgery have high priority.
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