Non-selective unilateral laryngeal reinnervation as salvage treatment after unsuccessful thyroplasty

Introduction:

Non-selective unilateral laryngeal reinnervation (ULR) is the surgical anastomosis between the recurrent laryngeal nerve (RLN) with a motor nerve in unilateral vocal fold paralysis (UVP). We present the results of nine patients in whom non-selective ULR was performed as salvage treatment after unsuccessful thyroplasty.

Methods:

Nine patients with UVP and persistent dysphonia after thyroplasty were included in this prospective, unicentric study. Reinnervation was achieved by surgical anastomosis between the RLN and the ansa cervicalis. Voice quality was measured by use of a questionnaire (Rouen Voice Questionnaire: 0 – 140), phoniatric voice evaluation (GRBAS-Scale, Hirano) and computer assisted voice analysis (shimmer, jitter, maximal phonation time in seconds, maximal intensity in dB) pre- and postoperative after 1 – 3, 12 or more months (m).

Results:

We observed significant improvement of self-evaluated voice quality measured by questionnaire (pre: 91.83, 1 – 3 m: 52, 36 m: 24 (p < 0.001)). Computerized phonation parameters significantly improved over time (jitter: pre: 3.25, 1 – 3 m: 1,49, 12 m: 1.14 (p =.01); shimmer: pre: 1.29, 1 – 3 m: 0.68, 12 m: 0.49 (p < .017). Maximal voice intensity significantly improved over time (max. intensity (dB): pre: 90.85 1 – 3 m: 91.1, 12 m: 96.4 (p < .012)). No significant improvement of maximal phonation time over time was observed (max. phonation time (s): pre: 8.77, 1 – 3 m: 8.9; 12 m: 12.88 p = 0.65). A significant improvement of externally assessed voice quality measured by the Hirano-score was observed.

Conclusions:

Non-selective ULR in UVP is a reliable and stable therapeutic option as salvage treatment for patients with persistent dysphonia after unsuccessful thyroplasty.

Publication History

Publication Date:
23 April 2019 (online)