Selective reinnervation for bilateral vocal cord paralysis using the superior laryngeal nerve

Bilateral vocal fold paralysis is an uncommon but potentially life-threatening condition that can be very difficult to treat. Thyroidectomy remains the most common cause of bilateral vocal fold paralysis. Current treatments can be divided into two groups: static and dynamic reconstruction. The vast majority of techniques currently performed are static techniques, which often trade increased airflow for decreased voice and potential aspiration. Dynamic reconstruction utilizing the phrenic nerve has been performed in humans; however, the potential risks to the hemidiaphragm are often unacceptable to patients who have already compromised respiratory function It is well known that the cricothyroid muscle is active in respiration, although its role is not entirely clear. Previous reports have demonstrated that the muscle contracts simultaneously with the posterior cricoarytenoid muscle (PCA). Furthermore, the ability of the external branch of the superior laryngeal nerve (EBSLN) to drive the PCA has been previously demonstrated in a feline model. Here, we report the first two cases of selective reinnervation of the PCA utilizing the EBSLN with good postoperative results.