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Main branch of ACN‐to‐RLN for management of laryngospasm due to unilateral vocal cord paralysis
Author(s) -
Wang Wei,
Sun Jianxiong,
Tang Haihong,
Gao Yingna,
Chen Shicai,
Li Meng,
Zheng Hongliang
Publication year - 2020
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.28426
Subject(s) - medicine , laryngospasm , phonation , recurrent laryngeal nerve , vocal cord paralysis , cord , anesthesia , surgery , anastomosis , larynx , paralysis , airway , audiology , thyroid
Objectives/Hypothesis This study explored the feasibility and efficiency of main branch of ansa cervicalis nerve (ACN)‐to‐recurrent laryngeal nerve (RLN) anastomosis for management of paroxysmal laryngospasm due to unilateral vocal cord paralysis (UVCP). Methods Thirteen patients who underwent main branch of ACN‐to‐RLN anastomosis for management of paroxysmal laryngospasm due to UVCP were enrolled in the present study. Multidimensional assessments, including videostroboscopy, voice assessment, and laryngeal electromyography (LEMG), were performed preoperatively and postoperatively. Results This series was limited to UVCP with iatrogenic causes, including thyroidectomy, cervical spine surgery, and thoracic surgery. After main branch of ACN‐to‐RLN anastomosis, all cases showed significant airway improvement, and laryngospasm was completely abolished in 92.3% (12 of 13) of cases. Videostroboscopy showed that the bulging and paradoxical adduction of the affected vocal cord during a sniff were abolished immediately after operation, and there was no significant difference in vocal fold position or glottal closure before versus after the operation. LEMG showed that the postoperative recruitment and amplitude of voluntary motor unit potential in the affected thyroarytenoid muscle during a sniff were significantly decreased compared to preoperative values, and postoperative recruitment showed significant improvement during phonation compared to that preoperatively. Voice assessment showed that there were no significant differences in overall grade, roughness, breathiness, jitter (local), shimmer (local), noise‐to‐harmonics ratio, or maximum phonation time after the operation compared to the preoperative values. Conclusions Main branch of ACN‐to‐RLN anastomosis could have long‐lasting efficacy in the management of paroxysmal laryngospasm due to UVCP, with no apparent compromise of voice quality. Level of Evidence 4 Laryngoscope , 130:2412–2419, 2020