Reinnervation of the unilaterally paralyzed larynx

Because of early success with reinnervation of the abductor musculature of bilaterally paralyzed larynges, experimental work and ultimately surgery in human patients has been undertaken to endeavor to apply the same basic concept to reinnervation of the unilaterally paralyzed larynx. A nerve-muscle pedicle is obtained from the omohyoid muscle in a manner identical to that previously reported. The lower 50% of the thyroid ala is carefully removed outside the perichondrial envelope and the lateral fibers of the thyroarytenoideus muscle (major laryngeal adductor) is exposed. The previously repaired nerve-muscle pedicle is inserted into this muscle to complete the procedure. The procedure has been undertaken in nine cases to date where the degree of posterior glottic chink, usually because of a concomitant superior nerve paralysis, was felt to be too great to be adequately managed by Teflon injection. Some degree of spontaneous return of adduction was accomplished in all nine cases.