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Published on: April 21, 2020
Primary and Delayed Non-Selective Laryngeal Reinnervation in Unilateral Vocal Fold Paralysis: A Single Tertiary
Nadhirah Mohd Shakri1, Chua Qi Shen2, Reem Salem Almohammadi3
1Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, 56000, Cheras Kuala Lumpur, Malaysia; Department of Otorhinolaryngology-Head and Neck Surgery, Hospital Canselor Tuanku Muhriz, Jalan Yaakob Latif, 56000, Cheras Kuala Lumpur, Malaysia.
Background:
Non-selective laryngeal reinnervation (NSLR) is performed for unilateral vocal fold paralysis (UVFP) either as a primary procedure following recurrent laryngeal nerve (RLN) injury during thyroidectomy or as a delayed intervention after established paralysis. Although both approaches have demonstrated favorable voice outcomes, comparative evidence regarding their long-term effectiveness remains limited.
Objective:
To evaluate and compare multidimensional voice outcomes between primary and delayed NSLR in patients with UVFP.
Methods:
Twenty-five patients were analyzed and categorized into primary (n = 11) and delayed (n = 14) groups. In the delayed group, neurogenic paralysis was confirmed using preoperative laryngeal electromyography and mobile cricoarytenoid joint on palpation prior to surgery. Multidimensional voice outcomes were assessed at baseline, 6 months, and 12 months, postoperatively. Statistical comparisons across timepoints were performed using Friedman and Wilcoxon signed-rank tests. Baseline parameters and 12-month outcomes between groups were compared using the Mann-Whitney U test.
Results:
Overall, significant improvements were observed in all multidimensional voice outcomes across timepoints (P < 0.05). The mean Bahasa Malaysia Voice Handicap Index-10 (mVHI-10) score improved from 18.40 to 7.01 at 12 months, while maximum phonation time (MPT) increased from 8.10 to 12.97 seconds. At 12 months, 80% of patients achieved normal to near-normal voice (mVHI-10 ≤ 11). In the primary group, significant improvements in mVHI-10 and MPT were observed at 12 months, with acoustic parameters remaining stable. The delayed group demonstrated significant improvements in all measured parameters at both 6 and 12 months. Although the primary group showed lower mean mVHI-10 scores and longer MPT at 12 months compared with the delayed group, these differences were not statistically significant.
Conclusion:
Both primary and delayed NSLR significantly improve multidimensional voice outcomes in UVFP. While early intervention may preserve near-normal voice function, delayed reinnervation remains effective, supporting NSLR as a viable treatment option regardless of timing in appropriately selected patients.
