Selective reinnervation of vocal cord adductors in unilateral vocal cord paralysis

Laryngeal reinnervation procedures were performed in a series of dogs. An attempt was made to reinnervate the vocal cord adductors with one nerve graft, while a different nerve was grafted to the abductors. The recurrent laryngeal nerve was dissected distally to its terminal branches, where the abductor-adductor sorting out occurs. The abductor branch was reinnervated with a phrenic nerve graft as previously described. The adductor division was grafted with one of the following nerves: proximal recurrent laryngeal, external branch of superior laryngeal, or ansa hypoglossi. Results revealed that in most cases it was indeed possible to reinnervate the adductive and abductive vocal cord muscles separately. Recurrent laryngeal nerve anastomosis to the distal adductor division produced strong reinnervation, but appeared to inhibit in some way the phrenic reinnervation of the abductor branch. Ansa hypoglossi anastomosis to the adductor division seemed to induce satisfactory reinnervation of the adductor musculature with the least noticeable donor deficit.