Functional Restoration for Recurrent Laryngeal Paralysis: An Experimental Study

Abstract

The purpose of this investigation was to exclude abductor disturbance and to maintain phonation during recurrent laryngeal nerve paralysis through a new surgical design. This new method consists of implantation of the ansa hypoglossi and sternothyroid muscle pedicle which has been shown to provide sufficient abductor function in a recent publication, and the selective severance ?f t~e abductor branch af~e! neurorrhaphy of the recurrent laryngeal which is shown to be a sufficient adductor function in another study.The recovery of sufficient abductor function during inspiration and dyspnea was 67 % and 89 % of adductor function with phonation. However, after cutting an ~d.ductor nerye branch of the recurrent laryngeal nerve in cases of ins1:1ff1cien~ ab~ucti.on, .the vocal cord on the operated-on side regained abduction durmg msp1rat10n.The effect of the ansa hypoglossi and sternothyroid muscle pedicle is also discussed. 0 INTRODUCTION.

Recent Advances in Phonosurgery

“…Direct reanas tomosis of the recurrent laryngeal nerve has been attempted first by many inves tigators (Horsley, 1909;Frazier, 1924;Lahey. 1928;Miehlke, 1958, Doyle et al, 1967Gordon and McCabe, 1968;Shimazaki, \951\Tomita, \961\Dedo, 1971;Murakami and Kirchner, 1971;Shin, 1971;Tashiro, 1972;Sato and Ogura, 1978a). Despite sporadic success reported, now it appears definite that this technique will not be followed by purposeful vocal cord movement, as clearly demonstrated by Boles and Fritzel (1969) for instance.…”

Reconstruction of Laryngeal Function for Recurrent Laryngeal Nerve Paralysis: Historical View, Advancement of Latest Investigations and a Preliminary Experiment

“…That is, the respiratory firings of the sternohyoid muscle on the electromyogram were usually irregular and not the rhythmic inspiratory activities, as reported in detail previously. 44 We question the validity of implantation of the sternohyoid muscle which these previous investigators used. However, these works are worthy of praise in advancing reconstructive surgery for recurrent laryngeal nerve paralysis, especially in view of possible human application.…”

Morphologic Correlates for Laryngeal Reinnervation

“…Ogura recognized the value of the NMP as an appropriate method for selectively reinnervating a specific muscle such as the PCA. In another 1978 publication with Sato, 15 he describes the value of the NMP.…”

“…“The rapid return of abductor function without special training in all cases suggests that the pedicle nerve muscle grafting technique (nerve‐muscular island technique) is the best and that the sternothyroid muscle is available as a substitute for the abductor.” 15 (p. 869)…”