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Isolated Recovery of Adductor Muscle Function Following Bilateral Recurrent Laryngeal Nerve Injuries
Author(s) -
Bach Ádám,
Sztanó Balázs,
Matievics Vera,
Bere Zsófia,
Volk Fabian,
Müller Andreas,
Förster Gerhard,
Castellanos Paul F.,
Rovó László
Publication year - 2019
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27718
Subject(s) - medicine , recurrent laryngeal nerve , glottis , laryngoscopy , cord , phonation , swallowing , electromyography , superior laryngeal nerve , adductor muscles , anesthesia , larynx , airway , vocal cord paralysis , peak flow meter , laryngeal paralysis , surgery , paralysis , physical medicine and rehabilitation , audiology , anatomy , intubation , thyroid , asthma
Objectives/Hypothesis The aim of this study was to analyze the phoniatric and respiratory outcomes of a subset of bilateral vocal cord paralysis (BVCP) patients who were all treated with unilateral endoscopic arytenoid abduction lateropexy (EAAL). EAAL is a nondestructive, minimally invasive glottis widening operation, which does not damage either the surgically treated or the contralateral vocal cord. Therefore, it does not impair the regeneration potential of the recurrent laryngeal nerve. Study Design Case series. Methods Ten out of 21 BVCP patients who were treated with EAAL showed signs of isolated adduction recovery at 1 year and were chosen for this study. Functional results (objective and subjective voice analysis, spirometric measurement) and vocal cord movements were assessed preoperatively, 1 week and 1 year after EAAL. Laryngeal electromyography was performed on the 12th postoperative month. Results The volitional adductor movement seen on laryngoscopy was corroborated by laryngeal electromyography evaluation. Peak inspiratory flow increased significantly after EAAL. Quality‐of‐life scores also showed high patient satisfaction. Shimmer showed consistent improvement along with harmonic‐to‐noise ratio and average maximal phonation time in parallel with the improving vocal cord movement. Complex voice analysis and subjective self‐evaluation tests also demonstrated significant improvement. Conclusions EAAL, as a minimally invasive, nondestructive airway widening technique, does not interfere with the potential regeneration process that can still occur after BVCP, allowing for laryngeal functional recovery. It is a safe and effective treatment for BVCP that allows a simple solution with good phonatory, swallowing, and respiratory benefits by unilateral passive and reversible vocal cord lateralization. Level of Evidence 4 Laryngoscope , 129:2334–2340, 2019