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Isolated Recovery of Adductor Muscle Function Following Bilateral Recurrent Laryngeal Nerve Injuries.
Laryngoscope. 2019 10; 129(10):2334-2340.L

Abstract

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.

Authors+Show Affiliations

Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Szeged, Hungary.Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Szeged, Hungary.Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Szeged, Hungary.Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Szeged, Hungary.Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.Department of Otorhinolaryngology, SHR Wald-Klinikum Gera, Gera, Germany.Department of Otorhinolaryngology, SHR Wald-Klinikum Gera, Gera, Germany.Northern Light Health Medical Center, Bangor, Maine, U.S.A.Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Szeged, Hungary.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

30548882

Citation

Bach, Ádám, et al. "Isolated Recovery of Adductor Muscle Function Following Bilateral Recurrent Laryngeal Nerve Injuries." The Laryngoscope, vol. 129, no. 10, 2019, pp. 2334-2340.
Bach Á, Sztanó B, Matievics V, et al. Isolated Recovery of Adductor Muscle Function Following Bilateral Recurrent Laryngeal Nerve Injuries. Laryngoscope. 2019;129(10):2334-2340.
Bach, Á., Sztanó, B., Matievics, V., Bere, Z., Volk, F., Müller, A., Förster, G., Castellanos, P. F., & Rovó, L. (2019). Isolated Recovery of Adductor Muscle Function Following Bilateral Recurrent Laryngeal Nerve Injuries. The Laryngoscope, 129(10), 2334-2340. https://doi.org/10.1002/lary.27718
Bach Á, et al. Isolated Recovery of Adductor Muscle Function Following Bilateral Recurrent Laryngeal Nerve Injuries. Laryngoscope. 2019;129(10):2334-2340. PubMed PMID: 30548882.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Isolated Recovery of Adductor Muscle Function Following Bilateral Recurrent Laryngeal Nerve Injuries. AU - Bach,Ádám, AU - Sztanó,Balázs, AU - Matievics,Vera, AU - Bere,Zsófia, AU - Volk,Fabian, AU - Müller,Andreas, AU - Förster,Gerhard, AU - Castellanos,Paul F, AU - Rovó,László, Y1 - 2018/12/13/ PY - 2018/09/11/received PY - 2018/10/23/revised PY - 2018/11/05/accepted PY - 2018/12/15/pubmed PY - 2019/11/5/medline PY - 2018/12/15/entrez KW - Quality of life KW - airway stenosis KW - dysphonia KW - laryngeal electromyography KW - vocal cord paralysis SP - 2334 EP - 2340 JF - The Laryngoscope JO - Laryngoscope VL - 129 IS - 10 N2 - 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. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/30548882/Isolated_Recovery_of_Adductor_Muscle_Function_Following_Bilateral_Recurrent_Laryngeal_Nerve_Injuries_ L2 - https://doi.org/10.1002/lary.27718 DB - PRIME DP - Unbound Medicine ER -