Pediatric recurrent laryngeal nerve reinnervation: A case series and analysis of post-operative outcomes

Farhood, Zachary; Reusser, Nicole M.; Bender, Robert W.; Thekdi, Apurva; Albright, James T.; Edmonds, Joseph L.

doi:10.1016/j.ijporl.2015.06.001

Cited by 14 publications

(9 citation statements)

References 11 publications

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“…Our data is congruent with previously published series that NSLR improves voice in children with unilateral neuronal VFMI . We are also the first to report CPP and CSID data in this patient population showing significant improvement postoperatively.…”

Section: Discussionsupporting

confidence: 92%

Predictors of voice outcome in pediatric non‐selective laryngeal reinnervation

et al. 2019

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Objectives: Non-selective laryngeal reinnervation (NSLR) using the ansa cervicalis to the recurrent laryngeal nerve (RLN) is a promising treatment option for pediatric unilateral neuronal vocal fold movement impairment (VFMI). The aim is to describe our clinical outcomes with this technique and to identify preoperative characteristics that may predict postoperative voice outcomes.Methods: This is a cohort study of pediatric patients with unilateral neuronal VFMI, who underwent NSLR from March 2012 to July 2018. Pre-and postoperative Pediatric Voice Related Quality of Life (PVRQOL) questionnaires, Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) ratings, and objective voice measures were obtained. In addition, patients underwent preoperative laryngeal electromyography (LEMG).Results: Thirty-two patients were identified. Twenty-one had complete data sets for analysis. The mean duration of VFMI was 9.02 years (range 1.1-26.1 years). There were significant improvements in PVRQOL (P = .0005), in all CAPE-V subsets (P ≤ .0001 to .0195), mean and maximum intensities (P = .0342 and 0.0110, respectively), cepstral peak prominence (P = .0001), and cepstral spectral index of dysphonia (P ≤ .0001). A worse preoperative LEMG correlated with a greater change in maximum phonation time (P = .0162) and maximum intensity (P = .0346). Age at injury and duration of injury had no significant impact on voice outcomes; however, patients with concurrent posterior glottic insufficiency did have smaller changes in PVRQOL (P = .012).Conclusion: NSLR is an effective treatment for pediatric unilateral neuronal VFMI even many years after initial RLN injury. LEMG may help predict voice outcomes of reinnervation in pediatric patients, but further data is still needed.

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Section: Discussionsupporting

confidence: 92%

Predictors of voice outcome in pediatric non‐selective laryngeal reinnervation

et al. 2019

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“…A systematic review stated that permanent treatment should ideally take place after a few years of observation and before the age of six years 1 . In our case, the age of 13 years with 12 years of denervation was not contraindicated, as experience with a beneficial effect of re-innervation after a long-term denervation period can be found in the literature 5 , 7 , 8 …”

Section: Discussionmentioning

confidence: 64%

“…1 In our case, the age of 13 years with 12 years of denervation was not contraindicated, as experience with a beneficial effect of re-innervation after a long-term denervation period can be found in the literature. 5,7,8 To evaluate the voice, standardised methods of assessment should be used. In cases of poor voice quality and young age, it can be challenging to assess voice quality objectively.…”

Section: Discussionmentioning

confidence: 99%

“…Based on existing clinical experience from the USA, it is considered safe. [4][5][6][7][8][9][10] Crumley was the first to describe ansa cervicalis to recurrent laryngeal nerve (RLN) anastomosis as a treatment option in children, during the 1980s. 11 In the Netherlands, and possibly in other European countries, there is little experience with laryngeal re-innervation in children, as there are no European publications on this subject to date.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of unilateral vocal fold paralysis with ansa cervicalis to recurrent nerve anastomosis in a young adolescent: European case report

et al. 2018

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“…Concurrent injection and reinnervation has been described for this indication previously. 13 A slight over-injection was performed, to mitigate the potential displacement of the injectate by intubation during the neck portion of the procedure. Neck incision was performed at the level of the cricoid cartilage lateral to the midline, measuring 4 cm.…”

Section: Methodsmentioning

confidence: 99%

The Nerve to Thyrohyoid Muscle as a Novel Donor Nerve for Laryngeal Reinnervation

Graham

Smith

2019

Ann Otol Rhinol Laryngol

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Objectives: Recurrent laryngeal nerve (RLN) injury may be a consequence of surgical procedures of the skull base, neck, and chest, with adverse consequences to function and quality of life. Laryngeal reinnervation offers a potentially stable improvement in vocal fold position and tone. The classic donor nerve is the ansa cervicalis, but is not always available due to damage or sacrifice during previous neck surgeries. Our objective was to introduce the nerve to the thyrohyoid (TH) muscle as an alternate donor nerve for reinnervation, which has not previously been described. Methods: Case series of two patients using the TH nerve for laryngeal reinnervation after RLN injury, with description of surgical harvest. Results: Follow-up results are available for 10 months (one patient) and 3 years (one patient) demonstrating both subjective and objective improvement in function. GRBAS scores were reduced. Maximal phonation time was improved. Patient rating of voice was stable or improved postoperatively. One patient described significant preoperative dyspnea which was significantly improved postoperatively, from a score of 24 to 10 out of 40 on the dyspnea handicap index. VHI was improved in one patient, but scores elevated in the other, despite a change from “moderately severe impairment” to “normal voice” subjectively. Neither patient experienced significant complications from the procedure. Conclusion: Laryngeal reinnervation procedures provide good outcomes in pediatric patients. When ansa cervicalis is not available as a donor nerve, the nerve to TH provides a reasonable alternative.

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Pediatric recurrent laryngeal nerve reinnervation: A case series and analysis of post-operative outcomes

Cited by 14 publications

References 11 publications

Predictors of voice outcome in pediatric non‐selective laryngeal reinnervation

Predictors of voice outcome in pediatric non‐selective laryngeal reinnervation

Treatment of unilateral vocal fold paralysis with ansa cervicalis to recurrent nerve anastomosis in a young adolescent: European case report

The Nerve to Thyrohyoid Muscle as a Novel Donor Nerve for Laryngeal Reinnervation

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