Surgical Considerations for Laryngeal Reinnervation and Future Research Directions
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NEUROLARYNGOLOGY (AJ MCWHORTER AND L ADKINS, SECTION EDITORS)
Surgical Considerations for Laryngeal Reinnervation and Future Research Directions Benjamin Anthony 1
&
Noah Parker 1 & Rita Patel 1 & Stacey Halum 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review This paper examines the history, current use, and future directions of laryngeal reinnervation surgery. Recent Findings Nonselective laryngeal reinnervation has been refined as a surgical technique for use in unilateral vocal fold paralysis. Selective laryngeal reinnervation is a viable surgical option for bilateral vocal fold paralysis. The use of laryngeal pacing devices, nimodipine, stem cells, and manipulation of the cellular and chemical microenvironment are future areas of study for laryngeal reinnervation. Summary While both thyroplasty and injection laryngoplasty are highly effective and remain the most popular treatment for unilateral vocal fold paralysis, nonselective laryngeal reinnervation offers several benefits that may help surgeons achieve superior results. Similarly, selective laryngeal reinnervation for treatment of bilateral vocal fold paralysis is a viable alternative to the life changing tracheostomy and potentially preserves laryngeal function better than iterations of posterior cordotomy surgery. Keywords Laryngeal reinnervation . Vocal cord paralysis . Vocal fold paralysis . Ansa recurrent laryngeal nerve reinnervation . Stem cell research . Laryngeal paralysis . Nonselective laryngeal reinnervation . Selective laryngeal reinnervation . Bilateral vocal fold paralysis . Unilateral vocal fold paralysis
Introduction In the early twentieth century, surgeons in the USA began experimenting with the idea of laryngeal reinnervation. Advances in laryngeal examination, thanks to the pioneering work by Chevalier Jackson, improved diagnosis of laryngeal pathologies such as unilateral and bilateral vocal fold paralysis. This improved diagnostic ability as well as detailed This article is part of the Topical collection on Neurolaryngology * Benjamin Anthony [email protected] Noah Parker [email protected] Rita Patel [email protected] Stacey Halum [email protected] 1
Indiana University Health Voice Center, 1130 W Michigan Street Suite 400, Indianapolis, IN 46202, USA
anatomical studies of laryngeal anatomy and function allowed for surgeons to contemplate the idea of reinnervating the larynx to restore lost mobility of the vocal fold after recurrent laryngeal nerve injury. The hope was to restore the normal functions of the larynx: abduction of the vocal folds during respiration, protection of the airway during swallowing, and adduction of the vocal folds during vocalization.
Background The first detailed description of a laryngeal reinnervation procedure was by Shelton Horsley MD from 1909 in the Annals of Surgery. Horsley described performing an end-to-end anastomosis of the recurrent laryngeal nerve after a woman sustained a gunshot wound to the neck with subsequent recurrent laryngeal nerve
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