Nonselective Reinnervation as a Primary or Salvage Treatment of Unilateral Vocal Fold Palsy

Marie, Jean‐Paul; Hansen, Karin Holmskov; Brami, P.; Marronnier, Adrien; Bon‐Mardion, Nicolas

doi:10.1002/lary.28324

Cited by 30 publications

(12 citation statements)

References 27 publications

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“…Patients with unilateral paralysis and unfavorable reinnervation (LS type II, III, IV) should be offered interventions for voice improvement. Especially in younger patients an unselective reinnervation with Ansa Cervicalis (combined with a temporary augmentation) as described by Crumley et al is a proven remedy 8,9,23‐25 . LEMG studies in those patients including PCA and may be even LCA clarify further why the Ansa Cervicalis procedure usually produces a type I result.…”

Section: Discussionmentioning

confidence: 97%

Crumley's Classification of Laryngeal Synkinesis: A Comparison of Laryngoscopy and Electromyography

et al. 2020

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Objectives/Hypothesis Applying the principles of misdirected nerve regeneration to the larynx, Roger Crumley in 1989 coined the term laryngeal synkinesis (LS) which he later (2000) classified into 4 types (type I – good voice, type II – involuntary twitches and poor voice, type III – adduction during inspiration, type IV – abduction during phonation). Neurophysiological data were not available for all LS patients at that time. The current study was undertaken to utilize and test the Crumley classification for a clinical interrater comparison and, secondly, compare predicted with actual laryngeal electromyography (LEMG) results. Study Design Descriptive study. Methods Laryngoscopic and LEMG data of patients with unilateral vocal fold paralysis (VFP) of 6 months duration or longer were combined for retrospective evaluation. Forty‐five data sets were available for laryngoscopic classification by two local laryngologists and by Roger Crumley. Twenty‐three data sets with complete thyroarytenoid (TA) and posterior cricoarytenoid (PCA) – EMG data were used to compare predicted with actual LEMG results. Results Local laryngologists were able to classify 24 of 45, Crumley 30 of 45 cases into one of the 4 synkinesis types. There was substantial agreement between examiners (Cohens Kappa 0.66 [P < .001]). Comparison of predicted and actual LEMG data showed only moderate agreement. EMG sykinesis rates were lower in TA than in PCA and highest in Crumley type I cases. Conclusion The Crumley classification is helpful in describing and understanding synkinesis. It does not always correlate predictably with actual LEMG data. A complete LEMG mapping of all intrinsic muscles may improve understanding of chronic VFP. Level of Evidence 4. Laryngoscope, 131:E1605–E1610, 2021

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Section: Discussionmentioning

confidence: 97%

Crumley's Classification of Laryngeal Synkinesis: A Comparison of Laryngoscopy and Electromyography

et al. 2020

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“…5 The fact that our hospital is an international reference center for the evaluation and surgery of laryngeal reinnervation has allowed our anesthesia team to perform this specific laryngoscopy procedure under spontaneous ventilation with remifentanil sedation/analgesia with TCI. [13][14][15] Spontaneous ventilation under remifentanil sedation/analgesia with TCI provides unobstructed surgical access but is a real challenge for the anesthesiologist who must constantly balance between adequate sedation/analgesia allowing rigid laryngoscope suspension while maintaining oxygenation and ventilation and also allowing the perfect phonic cooperation of the patient for the success and validity of the LEMG. Spontaneous ventilation with remifentanil sedation/analgesia with TCI is commonly used for adult SML in our center for several years and has replaced the use of jet ventilation.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Management for Awake Tubeless Suspension Microlaryngoscopy

et al. 2021

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Objectives/Hypothesis: Patients' eligibility for bilateral selective laryngeal reinnervation surgery is evaluated by suspension microlaryngoscopy (SML) examination with laryngeal electromyography (LEMG). Maintaining spontaneous ventilation, with remifentanil sedation/analgesia without endotracheal tube, to allow the patient to phonate with the surgeon during awake, LEMG is a major challenge for the anesthesiologist and the otorhinololaryngologist. The objective of this study was to evaluate the safety and efficacy of a novel anesthesia protocol to manage airway access during awake tubeless SML.Study Design: Retrospective study. Methods: Anesthesia records of patients undergoing awake SML with LEMG were retrospectively analyzed. Procedures were performed with remifentanil sedation/analgesia with targeted controlled infusion (TCI) in combination with local anesthesia. The main outcome was the failure rate of the anesthesia protocol during the procedure. Secondary outcomes were as follows: rate of apnea requiring ventilation, airway bleeding, regurgitation, hemodynamic data as well as vasopressor use, complications, and surgeon satisfaction with the procedure.Results: Data were obtained for 39 patients between November 2017 and September 2019, the mean age was 52 years and 29 (74%) were female. All procedures were completed without complications (0% [0-9]). Three patients (8% [1.6-20.8]) had an intraoperative episode of hypoxemia requiring mask reventilation. There was no airway bleeding, no regurgitation, and no hypotensive episode. Three patients (8% [1.6-20.8]) had noninvasive ventilation for respiratory distress after the end of the procedure.Conclusions: Our results show that awake tubeless SML allowing phonation during LEMG can be realized under sedation and local anesthesia. However, further data are needed concerning the intraoperative and postoperative safety of the procedure.

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“…Non-selective recurrent laryngeal reinnervation (NSLR) of the abductor and adductor intrinsic muscles of the larynx is achieved by anastomosing the RLN to itself or an adjacent motor nerve [23]. In comparison to static medialisation thyroplasty, NSLR confers a higher voice quality due to better vibrational capacity of the vocal cords [31,32] with more longterm stability owing to preserved laryngeal muscle bulk and tone [31]. It confers a significantly reduced risk of aspiration in children due to the improved glottic closure patterns [24].…”

Section: Reinnervationmentioning

confidence: 99%

Vocal cord palsy as a sequela of paediatric cardiac surgery – a review

et al. 2021

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Background: Vocal cord palsy is one of the recognised complications of complex cardiac surgery in the paediatric population. While there is an abundance of literature highlighting the presence of this complication, there is a scarcity of research focusing on the pathophysiology, presentation, diagnosis, and treatment options available for children affected by vocal cord palsy. Materials and methods: Electronic searches were conducted using the search terms: “Vocal Cord Palsy,” “VCP,” “Vocal Cord Injury,” “Paediatric Heart Surgery,” “Congenital Heart Surgery,” “Pediatric Heart Surgery,” “Vocal Fold Movement Impairment,” “VFMI,” “Vocal Fold Palsy,” “PDA Ligation.” The inclusion criteria were any articles discussing the outcomes of vocal cord palsy following paediatric cardiac surgery. Results: The two main populations affected by vocal cord palsy are children undergoing aortic arch surgery or those undergoing PDA ligation. There is paucity of prospective follow-up studies; it is therefore difficult to reliably assess the current approaches and the long-term implications of management options. Conclusion: Vocal cord palsy can be a devastating complication following cardiac surgery, which if left untreated, could potentially result in debilitation of quality of life and in severe circumstances could even lead to death. Currently, there is not enough high-quality evidence in the literature to aid recognition, diagnosis, and management leaving clinicians to extrapolate evidence from adult studies to make clinical judgements. Future research with a focus on the paediatric perspective is necessary in providing evidence for good standards of care.

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Nonselective Reinnervation as a Primary or Salvage Treatment of Unilateral Vocal Fold Palsy

Cited by 30 publications

References 27 publications

Crumley's Classification of Laryngeal Synkinesis: A Comparison of Laryngoscopy and Electromyography

Crumley's Classification of Laryngeal Synkinesis: A Comparison of Laryngoscopy and Electromyography

Anesthetic Management for Awake Tubeless Suspension Microlaryngoscopy

Vocal cord palsy as a sequela of paediatric cardiac surgery – a review

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