Pediatric Vocal Fold Immobility

Jabbour, Jad; Martin, Timothy J.; Beste, David J.; Robey, Thomas

doi:10.1001/jamaoto.2014.81

Cited by 97 publications

(50 citation statements)

References 22 publications

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“…Unilateral damage to the RLN impacts the behavior and performance of swallowing, both in human pediatric patients who have sustained injury (35,42) and in controlled animal models with a complete lesion (21)(22)(23). The results from these animal studies detail the impacts of such a lesion on performance and kinematics in a pediatric model (21)(22)(23).…”

Section: Testing the Effect Of A Lesion Of The Rln On Swallowingmentioning

confidence: 97%

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Impact of recurrent laryngeal nerve lesion on oropharyngeal muscle activity and sensorimotor integration in an infant pig model

DeLozier

Gould

Ohlemacher

et al. 2018

Journal of Applied Physiology

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The successful performance of a swallow requires dynamic integration between a wide range of sensory inputs and muscle activities to produce the coordinated kinematics of oropharyngeal structures. Damage to the recurrent laryngeal nerve (RLN) produces dysphagia in infants, with food or liquid entering the airway despite this nerve having minimal direct sensory or motor connections to the act of swallowing, apart from vocal fold closure. Previous results have demonstrated that a complete RLN lesion disrupts both performance and kinematics before initiation of the pharyngeal swallow in infants. We tested the hypothesis that a RLN lesion produces changes in the normal activity of oral floor, tongue, and infrahyoid muscles during a swallow. We recorded swallowing in our validated infant pig model, with synchronous high-speed imaging and fine-wire, chronic electromyography. We found changes in the timing, duration, and amplitude of the motor pattern in an array of muscles that are supplied by several different cranial and cervical nerves. Some of these changes in muscle activity are associated with the preparatory aspects of bolus aggregation or movement and so occur before the pharyngeal swallow. Taken with previous biomechanical results, these patterns suggest an intricate brain stem sensorimotor integration that occurs as part of a swallow. In particular, the execution of oral motor function is changed as a result of this simple lesion. NEW & NOTEWORTHY Damage to the recurrent laryngeal nerve compromises swallowing despite an absent or minimal contribution to either the motor or sensory aspects of this function. This study documents EMG changes, following RLN lesion, to non-RLN innervated muscles that are active during swallowing in an infant model. Some of these muscles fire before the pharyngeal swallow and are associated with the preparatory aspects of bolus aggregation and movement, suggesting important sensorimotor integration at a brain stem level.

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Section: Testing the Effect Of A Lesion Of The Rln On Swallowingmentioning

confidence: 97%

“…A lesion of the recurrent laryngeal nerve (RLN), a particular branch of CN X, is associated with dysphagia, a swallow where liquid enters the airway, either above or below the vocal folds (35,42,48). However, neither the sensory nor the motor components of the RLN directly contribute to bolus propulsion or to a safe swallow.…”

Section: Introductionmentioning

confidence: 99%

Impact of recurrent laryngeal nerve lesion on oropharyngeal muscle activity and sensorimotor integration in an infant pig model

DeLozier

Gould

Ohlemacher

et al. 2018

Journal of Applied Physiology

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show abstract

“…9,10 We found a median time to recovery of 6-months with a wide range from 1-month to 3-years ( Figure 1 ). This median is slightly longer than the 130-days found by Jabbour et al 10 Of the 19 patients who had recovery of function, 13 achieved this by 7-months after their cardiovascular surgery. The remaining six patients exhibited recovery over 1-year from their cardiovascular surgery.…”

Section: Recovery Of Functionmentioning

confidence: 91%

Outcomes of Vocal Fold Immobility After Pediatric Cardiovascular Surgery

Karas¹,

Patki²,

Ryan³

et al. 2019

Otolaryngol Open J

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Retrospective Study| Volume 5 | Number 2| 29 ABSTRACT Copyright 2019 by Raynor EM. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), which allows to copy, redistribute, remix, transform, and reproduce in any medium or format, even commercially, provided the original work is properly cited. cc ObjectivesCardiovascular surgery is increasingly performed in children for congenital malformations of the heart and great vessels. Observed as vocal fold immobility, recurrent laryngeal nerve injury is a well-described complication. As overall outcomes improve and patients live longer, the sequelae of vocal fold immobility amplify insignificance. Families are often unaware of the longterm issues related to vocal fold immobility especially with regard to need for alternative alimentation routes. We report on the incidence of use of feeding tubes, the timing of vocal fold function return and need for additional aerodigestive interventions. MethodsWe reviewed 65 patients <2-years who underwent cardiovascular surgery at a tertiary center from 2008-2013 and were diagnosed post-operatively with vocal fold immobility by fiberoptic examination. ResultsPatent ductus arteriosus and hypoplastic left heart syndrome were the most common of the cardiovascular anomalies included. The majority (92%) had unilateral left immobility. Recovery of motion was observed in 29% ranging from 1-month to 3-years. Hypoplastic left heart syndrome had a significant negative correlation with recovery. Forty-six percent required gastrostomy tube placement either to supplement their oral intake or to completely meet their nutritional needs. Forty-eight percent required subsequent aerodigestive surgery including direct laryngoscopy/bronchoscopy (22%), tracheostomy (8%) and vocal fold injection (5%). ConclusionCounseling of families and primary care providers regarding the impact of pediatric vocal fold immobility after cardiac surgery should include the high potential requirement for supplemental alimentation as well as the need for feeding and speech therapy. Longitudinal otolaryngology and speech pathology care is imperative with vocal fold immobility since the majority of these patients do not experience functional recovery and may require further interventions over time.

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“…Dysphagia may also result from disorders that affect the myoneural junctions, such as myasthenia gravis. Similarly, injury to branches of the vagus nerve, whose axons synapse within the medulla and pons of the brainstem, also frequently result in dysphagia (2)(3)(4). Swallowing is a complex, coordinated process involving 25 paired muscles, and five cranial nerves (sensory and motor) all coordinated by multiple brainstem and cortical loci (5).…”

Section: Introductionmentioning

confidence: 99%

Specific Vagus Nerve Lesion Have Distinctive Physiologic Mechanisms of Dysphagia

et al. 2019

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Swallowing is complex at anatomical, functional, and neurological levels. The connections among these levels are poorly understood, yet they underpin mechanisms of swallowing pathology. The complexity of swallowing physiology means that multiple failure points may exist that lead to the same clinical diagnosis (e.g., aspiration). The superior laryngeal nerve (SLN) and the recurrent laryngeal nerve (RLN) are branches of the vagus that innervate different structures involved in swallowing. Although they have distinct sensory fields, lesion of either nerve is associated clinically with increased aspiration. We tested the hypothesis that despite increased aspiration in both case, oropharyngeal kinematic changes and their relationship to aspiration would be different in RLN and SLN lesioned infant pigs. We compared movements of the tongue and epiglottis in swallows before and after either RLN or SLN lesion. We rated swallows for airway protection. Posterior tongue ratio of safe swallows changed in RLN (p = 0.01) but not SLN lesioned animals. Unsafe swallows post lesion had different posterior tongue ratios in RLN and SLN lesioned animals. Duration of epiglottal inversion shortened after lesion in SLN animals (p = 0.02) but remained unchanged in RLN animals. Thus, although SLN and RLN lesion lead to the same clinical outcome (increased aspiration), the mechanisms of failure of airway protection are different, which suggests that effective therapies may be different with each injury. Understanding the specific pathophysiology of swallowing associated with specific neural insults will help develop targeted, disease appropriate treatments.

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Pediatric Vocal Fold Immobility

Cited by 97 publications

References 22 publications

Impact of recurrent laryngeal nerve lesion on oropharyngeal muscle activity and sensorimotor integration in an infant pig model

Impact of recurrent laryngeal nerve lesion on oropharyngeal muscle activity and sensorimotor integration in an infant pig model

Outcomes of Vocal Fold Immobility After Pediatric Cardiovascular Surgery

Specific Vagus Nerve Lesion Have Distinctive Physiologic Mechanisms of Dysphagia

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