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Nerve-muscle pedicle flap implantation combined with arytenoid adduction.
Arch Otolaryngol Head Neck Surg. 2010 Oct; 136(10):965-9.AO

Abstract

OBJECTIVES

To describe a new technique of nerve-muscle pedicle (NMP) flap implantation combined with arytenoid adduction (AA) to treat dysphonia due to unilateral vocal fold paralysis and to examine postoperative vocal function.

STUDY DESIGN

Retrospective review of clinical records.

SETTING

Tertiary academic center.

PATIENTS

Twenty-two consecutive patients underwent NMP flap implantation with AA and were followed up short term over a period of 1 to 6 months (mean, 2.9 months) and long term over a period of 7 to 36 months (mean, 21.4 months).

INTERVENTIONS

An NMP flap was made using an ansa cervicalis branch and a piece of the sternohyoid muscle. A window was opened in the thyroid ala at the level of the vocal fold. Then, AA was performed and the NMP flap was securely implanted onto the thyroarytenoid muscle through the window under microscopic guidance.

MAIN OUTCOME MEASURES

The maximum phonation time, mean airflow rate, pitch range, and acoustic parameters (jitter, shimmer, and harmonics to noise ratio) were evaluated before surgery and twice after surgery.

RESULTS

All parameters improved significantly after surgery (P < .01). The measurements for maximum phonation time, mean airflow rate, and harmonics to noise ratio were within normal ranges after surgery. Furthermore, the maximum phonation time and jitter were significantly improved after long-term follow-up compared with early postoperative measurements (P < .01 and P < .05, respectively).

CONCLUSIONS

Precise harvest of an NMP flap and its placement directly onto the thyroarytenoid muscle combined with AA provided excellent vocal function. The NMP method may have played a certain role in the improvement of postoperative vocal function, although further study with electromyographic examination is required to clarify the innervation status of the thyroarytenoid muscle.

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Authors+Show Affiliations

Yumoto E
Department of Otolaryngology-Head and Neck Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, Japan 860-8556. yu6167@gpo.kumamoto-u.ac.jp
Sanuki T
No affiliation info available
Toya Y
No affiliation info available
Kodama N
No affiliation info available
Kumai Y
No affiliation info available

MeSH

AdultAgedAged, 80 and overArytenoid CartilageDysphoniaFemaleFollow-Up StudiesHumansLaryngeal MusclesMaleMiddle AgedMuscle, SkeletalPhonationRetrospective StudiesSpinal NervesSurgical FlapsVocal Cord Paralysis

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20956741

Citation

Yumoto, Eiji, et al. "Nerve-muscle Pedicle Flap Implantation Combined With Arytenoid Adduction." Archives of Otolaryngology--head & Neck Surgery, vol. 136, no. 10, 2010, pp. 965-9.
Yumoto E, Sanuki T, Toya Y, et al. Nerve-muscle pedicle flap implantation combined with arytenoid adduction. Arch Otolaryngol Head Neck Surg. 2010;136(10):965-9.
Yumoto, E., Sanuki, T., Toya, Y., Kodama, N., & Kumai, Y. (2010). Nerve-muscle pedicle flap implantation combined with arytenoid adduction. Archives of Otolaryngology--head & Neck Surgery, 136(10), 965-9. https://doi.org/10.1001/archoto.2010.155
Yumoto E, et al. Nerve-muscle Pedicle Flap Implantation Combined With Arytenoid Adduction. Arch Otolaryngol Head Neck Surg. 2010;136(10):965-9. PubMed PMID: 20956741.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nerve-muscle pedicle flap implantation combined with arytenoid adduction. AU - Yumoto,Eiji, AU - Sanuki,Tetsuji, AU - Toya,Yutaka, AU - Kodama,Narihiro, AU - Kumai,Yoshihiko, PY - 2010/10/20/entrez PY - 2010/10/20/pubmed PY - 2010/11/17/medline SP - 965 EP - 9 JF - Archives of otolaryngology--head & neck surgery JO - Arch Otolaryngol Head Neck Surg VL - 136 IS - 10 N2 - OBJECTIVES: To describe a new technique of nerve-muscle pedicle (NMP) flap implantation combined with arytenoid adduction (AA) to treat dysphonia due to unilateral vocal fold paralysis and to examine postoperative vocal function. STUDY DESIGN: Retrospective review of clinical records. SETTING: Tertiary academic center. PATIENTS: Twenty-two consecutive patients underwent NMP flap implantation with AA and were followed up short term over a period of 1 to 6 months (mean, 2.9 months) and long term over a period of 7 to 36 months (mean, 21.4 months). INTERVENTIONS: An NMP flap was made using an ansa cervicalis branch and a piece of the sternohyoid muscle. A window was opened in the thyroid ala at the level of the vocal fold. Then, AA was performed and the NMP flap was securely implanted onto the thyroarytenoid muscle through the window under microscopic guidance. MAIN OUTCOME MEASURES: The maximum phonation time, mean airflow rate, pitch range, and acoustic parameters (jitter, shimmer, and harmonics to noise ratio) were evaluated before surgery and twice after surgery. RESULTS: All parameters improved significantly after surgery (P < .01). The measurements for maximum phonation time, mean airflow rate, and harmonics to noise ratio were within normal ranges after surgery. Furthermore, the maximum phonation time and jitter were significantly improved after long-term follow-up compared with early postoperative measurements (P < .01 and P < .05, respectively). CONCLUSIONS: Precise harvest of an NMP flap and its placement directly onto the thyroarytenoid muscle combined with AA provided excellent vocal function. The NMP method may have played a certain role in the improvement of postoperative vocal function, although further study with electromyographic examination is required to clarify the innervation status of the thyroarytenoid muscle. SN - 1538-361X UR - https://www.unboundmedicine.com/medline/citation/20956741/Nerve_muscle_pedicle_flap_implantation_combined_with_arytenoid_adduction_ L2 - https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/10.1001/archoto.2010.155 DB - PRIME DP - Unbound Medicine ER -