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Selective Laryngeal Reinnervation With Separate Phrenic and Ansa Cervicalis Nerve Transfers
Julie T. van Lith-Bijl, MD;
Robin J. Stolk, MD;
Jeroen A. D. M. Tonnaer, PhD;
Cees Groenhout, MD;
Pierre N. M. Konings, PhD;
Hans F. Mahieu, MD, PhD
Arch Otolaryngol Head Neck Surg. 1997;123(4):406-411.
Abstract
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Objective
To perform selective reinnervation of the laryngeal abductor and adductor muscle groups after injury to the recurrent laryngeal nerve, recovering laryngeal function without impairment by synkinesis.
Design
Ten cats underwent the surgical procedure. To reinnervate the posterior cricoarytenoid muscle (abductor), a phrenic nerve graft was anastomosed to the main trunk of the recurrent laryngeal nerve. The adductor branch was severed, and the proximal stump was buried in the posterior cricoarytenoid muscle. The sternohyoid branch of the ansa cervicalis was anastomosed to the distal stump to reinnervate the adductor muscle group. After a period of 10 weeks, the laryngeal function was evaluated with videolaryngoscopy and electromyography of the posterior cricoarytenoid and vocalis muscles.
Results
Of the 10 cats, 9 could be evaluated. Laryngeal abductor function was comparable with the unaffected side in the 9 cats. During respiratory distress conditions, a minor compromise of the maximal abduction was observed in 5 cats. Phonation was not tested, but spontaneous adduction during expiration was seen in all cats. Reflex closure on ipsilateral, supraglottic, tactile mucosal stimulation was seen in only 2 cats. In each cat, evidence of nerve regeneration and reinnervation of both muscle groups was established with electromyography, electrical stimulation, and histological examination.
Conclusions
Using this selective reinnervation procedure, good laryngeal function can be achieved in the cat model, which may be applicable in humans. By reinnervation of the vocalis muscle, muscle tonus is achieved, which is expected to improve voice quality. Using this procedure, however, no active reflex closure may be expected.
Arch Otolaryngol Head Neck Surg. 1997;123:406-411
Author Affiliations
From the Department of Otolaryngology, Head and Neck Surgery, University Hospital Vrije Universiteit, Amsterdam (Drs van Lith-Bijl, Stolk, and Mahieu), and N. V. Organon, Scientific Development Group, Oss (Drs Tonnaer, Groenhout, and Konings), the Netherlands.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Laryngeal Abductor Reinnervation With a Phrenic Nerve Transfer After a 9-Month Delay
van Lith-Bijl et al.
Arch Otolaryngol Head Neck Surg 1998;124:393-398.
ABSTRACT
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