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Julie T. van Lith-Bijl, MD; Hans F. Mahieu, MD, PhD; Robin J. Stolk; Jeroen A. D. M. Tonnaer, PhD; Cees Groenhout, MD; Pierre N. M. Konings, PhD

Arch Otolaryngol Head Neck Surg. 1996;122(4):393-396.

Abstract
Objectives
To determine the influence of severity of neural injury of the recurrent laryngeal nerve on recovery of laryngeal abductor function and the importance of synkinesis.

Design
The recovery of laryngeal abductor function was studied in 30 cats after crushing (second-degree injury) or transection followed by neurorrhaphy (fifth-degree injury) of the recurrent laryngeal nerve, with a reinnervation period of 10 weeks.

Main Outcome Measures
Recovery of laryngeal abductor function was evaluated by videolaryngoscopy of spontaneous laryngeal abduction during respiration and by electromyography of the posterior cricoarytenoid and vocalis muscles. Neural lesions were applied unilaterally, and recovery of laryngeal function was compared with the contralateral unimpaired hemilarynx. Reinnervation was confirmed by histologic examination.

Results
After the recurrent laryngeal nerve was crushed, laryngeal abductor function was similar to normal after a 10-week reinnervation period in 19 of the 20 cats; after neurorrhaphy, no notable recovery of laryngeal abduction resulted in any of 10 cats. Electromyographic recordings disclosed synkinesis after neurorrhaphy and recovery of normal activity patterns after crush injuries.

Conclusions
Severity of neural injury to the recurrent laryngeal nerve influences the recovery of laryngeal abductor function. Damage to the endoneurium leads to misdirection of regenerating axons, inappropriate reinnervation, and synkinesis. No effective laryngeal function can then be expected.

(Arch Otolaryngol Head Neck Surg. 1996;122:393-396)

Author Affiliations
From the Department of Otolaryngology, Head, and Neck Surgery, University Hospital of the Vrije Universiteit, Amsterdam, the Netherlands (Drs van Lith-Bijl and Mahieu and Mr Stolk); and N. V. Organon Scientific Development Group, Oss, the Netherlands (Drs Tonnaer, Groenhout, and Konings).

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