Nonselective Reinnervation as a Primary or Salvage Treatment of Unilateral Vocal Fold Palsy

Nonselective Reinnervation as a Primary or Salvage Treatment of Unilateral Vocal Fold Palsy:

Objectives/Hypothesis

Demonstration of voice improvement and long‐term stability following nonselective unilateral laryngeal reinnervation (ULR) in patients with unilateral vocal fold paralysis (UVFP) and severe denervation. A subgroup of patients on whom ULR was performed as a salvage technique following unsuccessful medialization was analyzed separately.

Study Design

Prospective cohort study.

Methods

The ansa cervicalis–recurrent laryngeal nerve anastomosis technique was performed in all patients. Pre‐ and postoperative voice analysis included voice questionnaires, voice assessment by senior laryngologists using the Hirano Voice Scale, and computer‐assisted voice analysis at defined time points over the course of 36 months. Laryngeal electromyography (LEMG) and spirometry were performed before and 1 year after ULR.

Results

Significant linear improvement of mean voice quality over time was observed in the majority of parameters measured in 48 ULR patients and in eight ULR salvage patients. LEMG 1 year after ULR showed new recruitment. Mean voice quality remained stable during follow‐up in all ULR patients and in the ULR salvage group.

Conclusions

Nonselective ULR in UVFP is a reliable and stable therapeutic option for patients with high expectations concerning voice quality. The effect is stable in long‐term results. It is also a viable option for patients in whom conventional voice surgery failed to improve voice quality. We therefore propose ULR as salvage option in UVFP.

Level of Evidence

2b Laryngoscope, 2019