Compound Motor Action Potential Quantifies Recurrent Laryngeal Nerve Innervation in a Canine Model

Bhatt, Neel K.; Park, Andrea M.; Al‐Lozi, Muhammad; Paniello, Randal C.

doi:10.1177/0003489416637386

Cited by 9 publications

(17 citation statements)

References 27 publications

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“…CMAP does not rely on qualitative rating scales used with qualitative laryngeal electromyography, perceptual voice ratings, and vocal fold motion assessments. The addition of an objective measure may improve the accuracy of diagnosis and appropriate management . CMAP is widely used in the outpatient workup of other neuropathies, and transcutaneous stimulation of motor nerves can be achieved noninvasively.…”

Section: Discussionmentioning

confidence: 99%

“…CMAP is routinely used in the workup of many neuropathies, including facial nerve injuries, brachial plexus lesions, and spinal cord injuries . Laryngeal CMAP amplitude has been shown in animal models to quantitatively measure vocal fold innervation in both the physiologic and injured states . In short, laryngeal CMAP is produced upon stimulating the RLN, which elicits a measurable electrical potential within the laryngeal musculature …”

Section: Introductionmentioning

confidence: 99%

“…Whereas CMAP amplitude can be used to measure the degree of laryngeal innervation, CMAP duration and CMAP latency can also assess the properties of nerve conduction following injury . CMAP duration refers the time difference between the propagation of the first and last action potentials at the target muscle, which is affected by the variation in axon conduction velocities.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11] Laryngeal CMAP amplitude has been shown in animal models to quantitatively measure vocal fold innervation in both the physiologic 12 and injured states. 13 In short, laryngeal CMAP is produced upon stimulating the RLN, which elicits a measurable electrical potential within the laryngeal musculature. 13 Following injury to the RLN, the degree of recovery is affected by the severity of nerve injury.…”

Section: Introductionmentioning

confidence: 99%

“…13 In short, laryngeal CMAP is produced upon stimulating the RLN, which elicits a measurable electrical potential within the laryngeal musculature. 13 Following injury to the RLN, the degree of recovery is affected by the severity of nerve injury. 14 The Sunderland classification (1951) describes degrees of peripheral nerve injury.…”

Section: Introductionmentioning

confidence: 99%

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Compound motor action potential duration and latency are markers of recurrent laryngeal nerve injury

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Compound motor action potential duration and latency are markers of recurrent laryngeal nerve injury

et al. 2017

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Laryngeal adductor function following potassium titanyl phosphate laser welding of the recurrent laryngeal nerve

2019

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Objectives/Hypothesis Recurrent laryngeal nerve (RLN) transection injuries may occur during thyroidectomy and other surgical procedures. Laser nerve welding has been shown to cause less technique‐related axonal damage than the traditional suture method. We compared functional adductor results using these two methods of RLN repair. Study Design Animal model. Methods Canine hemilarynges underwent pretreatment testing of laryngeal adductor function, followed by RLN transection and repair using potassium titanyl phosphate (KTP) laser welding (n = 8) or microneural suture (n = 16) techniques. Six months later, adductor function was measured again and expressed as a proportion of the pretreatment value. Results The mean laryngeal adductor pressure ratios were 82.4% (95% confidence interval [CI]: 72.8%‐92.0%) for the laser repair group and 55.5% (95% CI: 49.4%‐61.6%) for the suture control group, with a difference of 26.9% (95% CI: 15.3%‐38.5%). Both spontaneous and stimulated glottic closure was observed in the laser welding and microsuture repair groups. Conclusions Laser nerve welding resulted in greater strength of adduction than suture repair of an acutely transected RLN. Suture anastomosis may traumatize more axons than the laser. Stronger vocal fold adduction is associated clinically with better protection from aspiration and improved voice outcomes. KTP laser welding should be considered for anastomosis of the RLN and other nerves. Level of Evidence NA Laryngoscope, 130:1764–1769, 2020

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Development of In‐Office Laryngeal Nerve Conduction Studies: Computed Tomography and Cadaveric Study

Bhatt

Darki

et al. 2020

The Laryngoscope

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In-office recurrent laryngeal nerve conduction studies (NCSs) are a technique that can potentially provide information about laryngeal innervation. NCS is essential in the management of other neuropathies including carpal tunnel syndrome and spinal cord injury. We hypothesize that laryngeal NCS may have similar utility in managing patients with vocal fold paralysis, atrophy, and neurodegenerative disease. NCSs are technically challenging because they require transcervical stimulation of the recurrent laryngeal nerve (RLN). This study combines radiographic data with cadaveric dissection to describe the anatomic parameters for optimal RLN stimulation.Study Design: Radiographic and Cadaveric Study. Methods: Fifty computed tomography scans were reviewed to determine the dimensions for ideal needle electrode placement. These values were compared to measurements from 12 fresh human cadaveric neck dissections. Ultrasound imaging was utilized in select cases. The neck was dissected to assess the accuracy of electrode placement.Results: Radiographically, the mean transcervical depth to the RLN was 33.2 mm AE 8.3 mm in males versus 29.4 mm AE 9.4 mm in females. The working space between the lateral trachea and carotid artery was 15.3 mm AE 3.6 mm on the right and 14.1 mm AE 2.9 mm on the left. After placement of stimulating electrodes into the cadaveric neck, the electrode tips were consistently within 8 mm of the RLN. Ultrasound guidance improved placement accuracy of the stimulating electrode.Conclusions: Laryngeal NCSs can provide detailed and objective information about laryngeal innervation that could dramatically improve the management of various neuropathies. In-office NCSs require technical precision, and this study describes anatomic factors that may affect the feasibility of performing this technique.

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Compound Motor Action Potential Quantifies Recurrent Laryngeal Nerve Innervation in a Canine Model

Abstract: The CMAP is a measure of vocal fold innervation. The technique could be further developed for clinical and experimental applications.

Cited by 9 publications

References 27 publications

Compound motor action potential duration and latency are markers of recurrent laryngeal nerve injury

Compound motor action potential duration and latency are markers of recurrent laryngeal nerve injury

Laryngeal adductor function following potassium titanyl phosphate laser welding of the recurrent laryngeal nerve

Development of In‐Office Laryngeal Nerve Conduction Studies: Computed Tomography and Cadaveric Study

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