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Pathophysiology and Surgical Treatment of Unilateral Vocal Fold Paralysis pp 119–153Cite as

Surgical Treatment of Unilateral Vocal Fold Paralysis; Reinnervation of the Thyroarytenoid Muscle

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Abstract

The author sought to achieve laryngeal reinnervation, with or without arytenoid adduction (AA), to treat severe breathy dysphonia caused by unilateral vocal fold paralysis. One surgical approach is primary reconstruction of the recurrent laryngeal nerve (RLN) immediately after extirpation of a thyroid or other malignant tumor. The RLN is reconstructed via direct suturing, interpolation of a free nerve graft between the severed stumps of the RLN, or transfer of the ansa cervicalis nerve (ACN). Another strategy features delayed reinnervation of the larynx in combination with AA. Nerve–muscle pedicle flap implantation into the thyroarytenoid muscle (a technique refined by the author) will also be described. This technique and nerve transfer involving the ACN both deliver excellent vocal function several months postoperatively. Laryngeal edema after AA attains its maximum extent on postoperative day (POD) 3 and then gradually (and significantly) subsides to POD 7. Both AA and type I thyroplasty negatively affect respiratory functioning, although no patient experienced dyspneic symptoms when performing daily activities.

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Authors and Affiliations

  1. Department of Otlaryngology Head and Neck Surgery, Graduate School of Medical Sciences Kumamoto University, Kumamoto, Japan

    Eiji Yumoto

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  1. Eiji Yumoto
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5.1 Electronic Supplementary Material

Video 5.1

Stroboscopic images of a 37-year-old female with left vocal fold paralysis (VFP). She underwent nerve–muscle pedicle (NMP) flap implantation and AA 20 months after onset of left VFP. Preoperatively, her voice was breathy and a wide glottal gap was evident during phonation. Six months postoperatively, her speaking voice was much improved and no glottal gap was noted during phonation, although the closed period was rather short. Sixteen months after surgery, her voice improved further and the closed period was longer than before. However, her higher tones sounded slightly breathy. At 24 months after surgery, she was satisfied with her voice because she could produce higher tones and sing songs with her children (MPG 19954 kb)

Video 5.2

Stroboscopic images of a 63-year-old male with left vocal fold paralysis (VFP). He underwent NMP flap implantation and AA 6 months after onset of left VFP. Preoperatively, his voice was very breathy and weak. A wide glottal gap was evident. Six months postoperatively, his voice had improved only slightly. Twelve months after surgery, he considered that his voice had improved. Vocal fold vibration was symmetrical and glottal closure was complete. However, the left ventricular fold exhibited adduction during phonation, suggesting that phonation was effortful. Twenty-one months postoperatively, his voice was normal, and a dynamic mucosal wave was evident. Left ventricular fold adduction was not noted (MPG 14100 kb)

Video 5.3

Stroboscopic images of a 48-year-old female with right vocal fold paralysis (VFP). She underwent ansa cervicalis nerve transfer and arytenoid adduction 12 months after onset of right VFP. Preoperatively, her voice was very breathy and weak. A wide glottal gap was evident. Six months postoperatively, her voice had improved. Vocal fold vibration was symmetrical and glottal closure complete. However, the left ventricular fold exhibited adduction during phonation, suggesting that phonation was effortful. Fifteen months after surgery, she could produce a high-pitched voice. Twenty-two months postoperatively, left ventricular fold adduction was not noted (MPG 10920 kb)

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Yumoto, E. (2015). Surgical Treatment of Unilateral Vocal Fold Paralysis; Reinnervation of the Thyroarytenoid Muscle. In: Pathophysiology and Surgical Treatment of Unilateral Vocal Fold Paralysis. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55354-0_5

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  • DOI: https://doi.org/10.1007/978-4-431-55354-0_5

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-55353-3

  • Online ISBN: 978-4-431-55354-0

  • eBook Packages: MedicineMedicine (R0)

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