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Main branch of ACN-to-RLN for management of laryngospasm due to unilateral vocal cord paralysis.
Laryngoscope. 2020 10; 130(10):2412-2419.L

Abstract

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.

Authors+Show Affiliations

Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China.Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China.Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China.Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China.Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China.Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China.Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31782810

Citation

Wang, Wei, et al. "Main Branch of ACN-to-RLN for Management of Laryngospasm Due to Unilateral Vocal Cord Paralysis." The Laryngoscope, vol. 130, no. 10, 2020, pp. 2412-2419.
Wang W, Sun J, Tang H, et al. Main branch of ACN-to-RLN for management of laryngospasm due to unilateral vocal cord paralysis. Laryngoscope. 2020;130(10):2412-2419.
Wang, W., Sun, J., Tang, H., Gao, Y., Chen, S., Li, M., & Zheng, H. (2020). Main branch of ACN-to-RLN for management of laryngospasm due to unilateral vocal cord paralysis. The Laryngoscope, 130(10), 2412-2419. https://doi.org/10.1002/lary.28426
Wang W, et al. Main Branch of ACN-to-RLN for Management of Laryngospasm Due to Unilateral Vocal Cord Paralysis. Laryngoscope. 2020;130(10):2412-2419. PubMed PMID: 31782810.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Main branch of ACN-to-RLN for management of laryngospasm due to unilateral vocal cord paralysis. AU - Wang,Wei, AU - Sun,Jianxiong, AU - Tang,Haihong, AU - Gao,Yingna, AU - Chen,Shicai, AU - Li,Meng, AU - Zheng,Hongliang, Y1 - 2019/11/29/ PY - 2019/08/20/received PY - 2019/10/12/revised PY - 2019/11/04/accepted PY - 2019/11/30/pubmed PY - 2020/12/15/medline PY - 2019/11/30/entrez KW - Larynx KW - laryngeal reinnervation KW - laryngospasm KW - synkinesis KW - vocal fold paralysis SP - 2412 EP - 2419 JF - The Laryngoscope JO - Laryngoscope VL - 130 IS - 10 N2 - 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. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/31782810/Main_branch_of_ACN_to_RLN_for_management_of_laryngospasm_due_to_unilateral_vocal_cord_paralysis_ L2 - https://doi.org/10.1002/lary.28426 DB - PRIME DP - Unbound Medicine ER -