Reinnervation of the paralyzed larynx: a review

Our high-speed and increasingly aggressive society, coupled with a continuing rise in necessary surgery of the neck and adjacent areas, accounts for the current increase in patients affilicted with vocal-cord paralysis. Such patients may sustain relatively little persistent loss of function (e.g., when only one cord is involved, which then regains function or becomes compensated) or considerable loss (as in cases of bilateral vocal-cord paralysis). To improve on existing methods of dealing with these problems, the author has developed and refined the nerve-muscle-pedicle technique for reinnervating paralyzed muscles. A nerve-muscle pedicle obtained from the ansa hypoglossi branch to the omohyoid muscle or another strap muscle can be used to selectively reinnervate the posterior cricoarytenoid muscle in cases of bilateral-cord paralysis, or for selective reinnervation of the lateral thyroarytenoid muscle in cases of unilateral-cord paralysis. The bilateral reinnervation technique showed a 90% success rate in 90 patients, as demonstrated by their ability to sustain reasonable day-to-day activity without needing a tracheotomy tube and without manifesting further loss of voice. The unilateral technique has yielded promising results in a limited number of carefully selected patients.