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Laryngeal Reinnervation Restores Vocal Function at Decreased Risk: Presented at AAO-HNS

By Jacquelyn Beals

WASHINGTON, DC -- September 21, 2007 -- Reinnervation of the larynx by nerve-nerve anastomosis can restore function to a paralysed vocal fold without the increased risks or complications that accompany laryngeal framework surgery, researchers noted in a presentation here on September 18th at the Annual Meeting of the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) Foundation.

"Rehabilitation is aimed at restoring glottic competence," said Joel H. Blumin, MD, Associate Professor and Chief, Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin.

Reinnervation "adds bulk, tone, and position stability to the vocal folds," said Dr. Blumin. It also provides another reliable and safe option for the patient.

Dr. Blumin noted that the safety of reinnervation had not been evaluated, so he and a colleague undertook a retrospective comparison of the charts of patients who had traditional laryngeal framework surgery, with and without laryngeal reinnervation, over a 5-year period.

Among the 15 patients who completed the reinnervation procedure to restore function to a paralysed vocal fold, 12 also had adduction of the arytenoid cartilage, and three underwent other laryngeal procedures. No airway obstruction or death was reported. There was no long-term dysphagia and no aspiration pneumonia. Post-operative endoscopy revealed that three of the 12 patients who had reinnervation and arytenoid adduction showed ecchymoses in the pharynx.

The occurrence of minor complications was the same, whether framework surgery was performed with or without reinnervation (P >.05).

The average age of reinnervation patients in this study was 48 years; the control group patients, who received only framework procedures, averaged 58 years of age. Dr. Blumin observed that reinnervation is more commonly performed in younger patients. Patients' charts were reviewed for complications, and data from the two groups were analysed using paired t-tests.

During laryngeal framework surgery, patients are typically awake but sedated and free from pain. To prevent possible complications, the surgeon verified the correct side with the patient, and intraoperative electromyography was performed to reveal which nerve was responsive. No contralateral paralysis occurred following surgery.

Laryngeal framework surgery alters the cartilage framework of the larynx to improve the position or shape of the vocal folds and their vibration. Performed to improve vocal function, the surgery treats patients with paresis/paralysis of the vocal folds or tissue loss following cancer resection. Laryngeal framework surgery may involve the arytenoid cartilage, cricoid cartilage, or thyroid cartilage -- all structural components of the larynx.


[Presentation title: Safety of Laryngeal Reinnervation.]

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