Hypoglossal Nerve Transfer for Laryngeal Reinnervation: A Preliminary Study

Abstract

The hypoglossal nerve is a logical donor nerve for hemilaryngeal reinnervation because 1) its activity coincides with normal laryngeal adduction during speech and deglutition; 2) it is a large nerve with many axons; and 3) donor site morbidity is low. This method of laryngeal reinnervation has not been previously reported. Previous studies using the ansa cervicalis for reinnervation have failed to show spontaneous activity. Hypoglossal-to-recurrent laryngeal nerve anastomosis was performed on a series of 5 dogs. The vocal folds were viewed monthly, with the animals awake, by infraglottic examination through a permanent tracheostomy. One dog failed due to technical error. The remaining 4 dogs began to exhibit spontaneous vocal fold adduction within 2 to 4 months. Vocal fold motion was synchronous with spontaneous tongue motion. Complete glottic closure was seen during swallowing at 3 to 5 months. Intraglottic pressure measurements following reinnervation were normal. Hypoglossal nerve transfer appears to be capable of providing functional adduction to the paralyzed hemilarynx. The potential advantages and disadvantages of this new technique are discussed.

Effects of Long‐Term Denervation on the Rat Thyroarytenoid Muscle

“…Thus, it is desirable to perform reinnervation procedures in addition to the above‐mentioned treatments to restore a near‐normal voice in patients with UVFP. Numerous studies of reinnervation procedures to denervated TA muscle have been reported 1–3 . In the clinical setting, some patients suffer from hoarseness caused by UVFP for years.…”

“…Numerous studies of reinnervation procedures to denervated TA muscle have been reported. [1][2][3] In the clinical setting, some patients suffer from hoarseness caused by UVFP for years. However, few studies have been conducted regarding muscle atrophy over a long period.…”

Laryngeal Reinnervation With the Hypoglossal Nerve: II. Clinical Evaluation and Early Patient Experience

“…In a series of canine studies, is was shown that complete adductory motion was restored to the paralyzed hemilarynx by XII-RLN reinnervation, with a return to normal glottic closing pressures. 21,22 These results, obtained with anastomosis to either a full XII or a split XII, were superior to those obtained in dogs undergoing ansa cervicalis reinnervation or XII-RLN with a 2-cm interposition graft.…”

Selective reinnervation of the posterior cricoarytenoid and interarytenoid muscles: An anatomical study

“…There remains a need for a definitive surgical procedure to address BVFP in humans. Most studies to date have examined unilateral paralysis, and have found solutions in animals and increasingly in humans 8. The main challenges to reinnervation procedures, but particularly to bilateral procedures, according to the literature, have proven to be: 1) ensuring timely reinnervation; 2) finding a suitable technique, and with schemas such as ours; and 3) surmounting the respiratory challenges that are presented by employing the phrenic nerve in anastomosis.…”