Recurrent Laryngeal Nerve Section for Spastic Dysphonia

Abstract

Spastic dysphonia is a severe vocal disability in which a person speaks with excessively adducted vocal cords. The resulting weak phonation sounds tight, as if he were being strangled, and has also been descrived as laryngeal stutter. It is often accompanied by face and neck grimaces. In the past it has been regarded as psychoneurotic in orgin and treated with speech therapy and psychotherapy with disappointing results. Because of laboratory and clinical observation that recurrent nerve paralysis retracts the involved vocal cord from the midline, it was proposed that deliberate section of the recurrent nerve would improve the vocal quality of patients with spastic dysphonia. In 34 patients the recurrent nerve was sectioned after Xylocaine temporary paralysis showed significant improvement in vocal quality. Several patients have been advised against this operation because of the type of voice they developed with one vocal cord temporarily paralyzed. With nerve section plus postoperative speech therapy, approximately half of the patients have returned close to a "normal" but soft phonatory voice. The rest had varying degrees of improvement, but all, so far, have been pleased with the improvement in ease and quality of phonation and reduction or elimination of face and neck grimaces. Two men have a breathy component in their phonatroy voices, and one woman has variable pitch.

Dystonia of the Oromandibular, Lingual and Laryngeal Areas

“…55 The dose requirements vary between patients and are not specific to the age or gender of the patient. 56 Complications of BoNT injections include transient breathy hypophonia, hoarseness, swallowing difficulties and pain. More serious complications include more severe dysphagia or airway compromise.…”

Avaliação vocal e da qualidade de vida em pacientes com distonia laríngea em tratamento com toxina botulínica

“…A DL, também referida pela literatura como disfonia espasmódica, em decorrência do seu principal sintoma, a presença de espasmos (Gowers, 1899;Dedo, 1976;Aminoff et al, 1978;Ludlow et al, 1991;Hallet, 1998, Roy, 2010, é um tipo de distonia focal de ação-indução, ou tarefa dependente, que afeta o controle motor laríngeo (Brin et al, 2009;Ludlow, 2011;Meyer et al, 2012).…”

“…É reconhecida e referida pela literatura como disfonia espasmódica, devido ao seu principal sintoma, a presença de espasmos (Gowers, 1899;Dedo, 1976;Aminoff et al, 1978;Hallet et al, 1998;Roy, 2010), com prevalência de 5,9…”

“…terapia fonoaudiológica Woodson, 1995;Silverman et al, 2012), terapias alternativas (Pearson;Sapienza, 2003), diferentes técnicas cirúrgicas como: secção do nervo laríngeo recorrente (NLR), que gera denervação dos músculos da laringe (Dedo, 1976), miotomia do músculo tireoaritenoideo (TA), dificultando as contrações involuntárias (Genack et al, 1993;Shaw et al, 2003), avulsão unilateral do NLR (Netterville et al, 1991), denervação bilateral, com reinervação do músculo TA (Berke et al, 1999;Allegretto et al, 2003), tireoplastia tipo II (Isshiki et al, 2000(Isshiki et al, , 2001 e mais recentemente, a neurectomia endoscópica do ramo TA do nervo laríngeo inferior combinado com laser de CO2 e miectomia parcial do músculo TA (Tsuji et al, 2012).…”

“…É reconhecida e referida pela literatura como disfonia espasmódica, devido ao seu principal sintoma, a presença de espasmos (Gowers, 1899;Dedo, 1976;Aminoff et al, 1978;Hallet et al, 1998;Roy, 2010), com prevalência de 5,9 casos para cada 100.000 indivíduos (Asgeirsson et al, 2006), e envolve cinco diferentes tipos: adução, abdução, mista, respiratória adutora e do cantor. A maior incidência é de distonia larínge de adução (DLAD) (Blitzer, 2010), e sua maior prevalência ocorre em mulheres (Cannito et al, 2004;Blitzer, 2010).…”