Role of reinnervation in the management of recurrent laryngeal nerve injury: current state and advances

  title={Role of reinnervation in the management of recurrent laryngeal nerve injury: current state and advances},
  author={Virginia Fancello and S. A. Reza Nouraei and Kate J Heathcote},
  journal={Current Opinion in Otolaryngology \& Head and Neck Surgery},
Purpose of review To present the current state of knowledge concerning different laryngeal reinnervation procedures for unilateral and bilateral vocal palsy. Recent findings Recent reports show positive outcomes on both unilateral and bilateral reinnervations. The phrenic nerve is the most commonly used donor for bilateral vocal palsy, but use of the superior laryngeal nerve has also been suggested. Summary Reinnervation of the larynx is a complex undertaking that can be performed by ENT… 

Recurrent laryngeal nerve reinnervation: is this the standard of care for pediatric unilateral vocal cord paralysis?

Although NSLR appears to work, the voice results are not perfect for all children and further work is being done to understand which preoperative variables, such as age, time from injury, and preop laryngeal electromyography, may predict a better voice outcome.

Paediatric reinnervation update

With this review, it is hoped to encourage further international collaborations and investigation in this field, since the benefits of the techniques appear to be particularly promising in paediatric patients.

Decision Making Around Reinnveration

A detailed understanding of laryngeal reinnervation, including patient factors, surgical techniques, post-operative outcomes, advantages, and drawbacks, can help to most effectively counsel and treat patients with vocal fold paralysis.

Bilateral Selective Laryngeal Reinnervation for Bilateral Vocal Fold Paralysis in Children.

Bilateral SLR appears to be a promising treatment option for children with BVFP and the only option, to the authors' knowledge, with the potential to restore abductor and adductor vocal fold movement and be considered as a first-line technique before endolaryngeal or airway framework procedures, which carry a risk of compromising voice quality.


Functional Voice Therapy started just after healing of the postoperative wound in the neck eliminated abnormal compensatory mechanisms of phonation and is an opportunity to quickly return laryngeal function and prevents unwanted secondary functional mechanisms within the vocal organ.

A narrative review of current therapies in unilateral recurrent laryngeal nerve injury caused by thyroid surgery.

Current common treatments in recurrent laryngeal nerve injury (RLNI) are summarized and compared, and nerve tissue engineering technology in RLNI animal models is introduced.

Long-Term Interventions for Bilateral Vocal Fold Paralysis: Endoscopic and Open Procedures

Surgical interventions include endoscopic techniques such as cordotomy, arytenoidectomy, and suture lateralization procedures, as well as open procedures such as posterior cricoid split with graft and tracheostomy, which are illustrated in this chapter.

Paraganglioma of the recurrent laryngeal nerve

This case is unique given the patient presentation due to ipsilateral vocal fold paralysis, which has not previously been reported, lack of previous surgery, and demonstration of loss of succinate dehydrogenase iron‐sulfur subunit B expression.

Autologous Fat Injection Laryngoplasty for Unilateral Vocal Fold Paralysis

AFIL improves the perceptual outcome and some voice parameters in short-term and long-term results, i.e., jitter, shimmer, and maximal phonation time (MPT).



Long-Term Results of Nerve-Muscle Pedicle Reinnervation for Laryngeal Paralysis

  • H. Tucker
  • Medicine
    The Annals of otology, rhinology, and laryngology
  • 1989
Successful reinnervation of unilateral paralyses usually maintains voice correction indefinitely, but there is late (2 to 5 years postsurgery) deterioration of successful airway restoration in approximately 17% of bilateral cases, which appears to be due to development of cricoarytenoid arthritis.

Laryngeal Reinnervation Using the Split-Phrenic Nerve-Graft Procedure

Initial successes in a series of animals have shown that use of the split-phrenic nerve-graft procedure results in functional abduction of the paralyzed vocal cord, while preserving innervation to the diaphragm.

Laryngeal reinnervation.

  • R. Paniello
  • Medicine
    Otolaryngologic clinics of North America
  • 2004

Outcomes of Laryngeal Reinnervation for Unilateral Vocal Fold Paralysis in Children

In pediatric ansa-RLN reinnervation for UVFP, no correlation between age at surgery and postoperative outcome was found and duration showed slight negative correlation, similar to what has been reported in adults, though voice improvement was seen in all patients.

Selective reinnervation for bilateral vocal cord paralysis using the superior laryngeal nerve

The first two cases of selective reinnervation of the PCA utilizing the EBSLN with good postoperative results are reported, which are previously demonstrated in a feline model.

Laryngeal abductor reinnervation with a phrenic nerve transfer after a 9-month delay.

Delayed selective laryngeal abductor reinnervation was feasible, but function recovery was less successful than if performed immediately, and future investigations should concentrate on early determinants of spontaneous restoration of function to allow early selection of patients who are eligible for reinn conservation surgery.

Selective Reinnervation of the Abductor and Adductor Muscles of the Canine Larynx after Recurrent Nerve Paralysis

Functional rehabilitation of the larynx after unilateral vocal cord paralysis was attempted in the dog by selective reinnervation of the laryngeal muscles. The intralaryngeal branches of the right

Newer Technique of Laryngeal Reinnervation: Superior Laryngeal Nerve (Motor Branch) as a Driver of the Posterior Cricoarytenoid Muscle

The neurotization technique has been selected for further experimentation in human adults and vocal fold mobilization on the right side is revealed to have an average of about half of the mobility of the left, normal side.