The evolution of laryngeal reinnervation, the current state of science and thoughts for future treatments

The treatment of unilateral vocal fold palsy (UVFP) or bilateral vocal fold palsy (BVFP) has been the subject of debate and experiment for 150 years. To date, dozens of different surgical methods have been described to reinnervate this most complex of organs, the larynx. As yet, there is no consensus on the most functionally effective method of reinnervation. However, it is a rapidly expanding area of research and remains an area of controversy. Indications for reinnervation for both UVFP and BVFP are still evolving and our understanding of the neuromuscular supply to the larynx continues to expand. What may have been considered unacceptable results from previous studies with one pathology may actually be of benefit in patients with different pathologies. This uncertainty of treatment options and potential outcomes can be confusing. In addition alternative techniques have been postulated as mainstays or adjuncts of treatment to the stalwart of reinnervation, neurorrhaphy. Determining what the correct treatment for an individual patient should be is still a gray area. With this in mind, this article reviews the evolution of laryngeal reinnervation, reviews the current state of the science, and suggests directions in which it might move in the future.