Laryngeal Abductor Reinnervation With a Phrenic Nerve Transfer After a 9-Month Delay

Abstract

Delayed selective laryngeal abductor reinnervation was feasible, but function recovery was less successful than if performed immediately. Future investigations should concentrate on early determinants of spontaneous restoration of function to allow early selection of patients who are eligible for reinnervation surgery.

Reinnervation of Bilateral Posterior Cricoarytenoid Muscles Using the Left Phrenic Nerve in Patients with Bilateral Vocal Fold Paralysis

“…This was consistent with some previous reports [31-34]. Secondly, progressive atrophy with denervation time may impair the regenerative capacity of skeletal muscles owing to irreversible pathologic alterations, such as muscle fibrosis and degeneration of muscle endplates [6]. If bilateral RLNs are completely transected, the degree of subclinical reinnervation is less, the atrophy of PCA muscles is more severe.…”

“…The first important factor that may have influenced the outcome of surgery is the interval between the phrenic nerve transfer procedure and the onset of bilateral RLN injury. Theoretically, better results of reinnervation surgery are obtained if the interval between the injury and reinnervation is shorter, as is shown both in the literature and in our experimental study [6,30]. We performed the phrenic nerve transfer surgery for some BVFP patients with thyroid surgery-related RLN injury within 6 months after the injury, there are some reasons.…”

Intrinsic laryngeal muscle reinnervation with nerve‐muscle pedicle

“…This technique may be considered either soon after loss of function or in selected cases after longstanding bilateral RLN or vagus nerve paralysis when spontaneous recovery is hopeless. 11 Laryngeal NMP technique transfers intact functioning motor endplates from the SH muscle located at the end of the ansa cervicalis in our case. 18 The reinnervated muscle takes the characteristics of its supplying nerve; consequently, the selection of the donor nerve should depend on the muscle fiber composition of the muscle to be reinnervated.…”

“…In clinical practice, there is usually a considerable delay between injury to the RLN and presentation for treatment. 11 A reduction in muscle fiber size as early as 2 weeks after denervation, followed by muscle atrophy after 8 weeks, is reported. 8 Duration of paralysis before surgery does not influence functional recovery because successful reinnervation has been achieved 50 and 22 years after the paralysis.…”

Effect of duration of denervation on outcomes of ansa‐recurrent laryngeal nerve reinnervation

“…For example, selective reinnervation of the posterior cricoarytenoid muscle with a phrenic nerve transfer has been feasible after a 9-month delay in cat models; however, functional recovery was less successful than with immediate reinnervation. 14 We previously reported that laryngeal reinnervation is still possible to some degree, even after an 18-month denervation period in dogs; however, the degree of RLN regeneration is less than those with an 8-month denervation period. 8 In the clinical studies, Maronian et al reported on nine patients, eight of whom had an interval between RLN injury and surgery that exceeded 12 months.…”