Histochemical Study of Posterior Cricoarytenoid Muscle Reinnervation by a Nerve-Muscle Pedicle in the Cat

1987 ◽  
Vol 96 (5) ◽  
pp. 479-487 ◽  
Author(s):  
Joseph J. Fata ◽  
Leslie T. Malmgren ◽  
Richard Dum ◽  
Richard R. Gacek ◽  
Peak Woo
Keyword(s):  
Electrical Stimulation ◽  
Vocal Cord ◽  
Spontaneous Respiration ◽  
Glycogen Depletion ◽  
Quantitative Evidence ◽  
Airway Occlusion ◽  
Posterior Cricoarytenoid Muscle ◽  
Posterior Cricoarytenoid ◽  
Nerve Muscle ◽  
And Control

Reinnervation of the posterior cricoarytenoid (PCA) muscle with a nerve-muscle pedicle (NMP) has been proposed for patients with bilateral abductor vocal cord paralysis. Since its success has been controversial, a glycogen depletion histochemical technique was used to examine reinnervation. An ansa cervicalis NMP was implanted into the denervated PCA in nine cats. Eight months later, vocal cord activity was evaluated. The NMP nerve was stimulated extensively in seven cats (experimental group). Optical densities of NMP-supphed PCA muscle fibers from experimental and control groups were compared to detect differences in glycogen content. The results demonstrated quantitative evidence of reinnervation in two experimental animals. Electrical stimulation of the NMP produced abduction in one of these two animals, but was never observed during spontaneous respiration or airway occlusion. These observations indicate that reinnervation can occur but abduction requires electrical stimulation. The NMP technique may be more successful with an electrical pacer.

Reinnervation of the Canine Posterior Cricoarytenoid Muscle with Sympathetic Preganglionic Neurons

1990 ◽  
Vol 99 (3) ◽  
pp. 167-174 ◽  
Author(s):  
Ian N. Jacobs ◽  
Bei-Lian Wu ◽  
Ira Sanders ◽  
Hugh F. Biller
Keyword(s):  
Vocal Cord Paralysis ◽  
Fiber Type ◽  
Electromyographic Activity ◽  
Glycogen Depletion ◽  
Bilateral Vocal Cord Paralysis ◽  
Preganglionic Neurons ◽  
Posterior Cricoarytenoid Muscle ◽  
Posterior Cricoarytenoid ◽  
The Right ◽  
Stimulation Of

This experiment investigated the reinnervation of the canine posterior cricoarytenoid (PCA) muscle with preganglionic neurons of the sympathetic nervous system. Six dogs had their right recurrent laryngeal nerve (RLN) sectioned. Four of these dogs had the sympathetic cervical trunk (SCT) implanted into the right PCA muscle, and the two remaining dogs served as denervated controls. Four months later all dogs underwent videolaryngoscopy, electromyography, and electrical stimulation of the SCT. The PCA muscles were excised, sectioned, and stained for glycogen and ATPase. All four experimental PCA muscles demonstrated electrically evoked abduction and tonic electromyographic activity. In two of the specimens, staining (ATPase and PAS) revealed areas of reinnervation with fiber type grouping and glycogen depletion. These results are consistent with the successful reinnervation of the PCA muscle. Further refinement of this technique could be of benefit to patients with bilateral vocal cord paralysis.

Laryngeal response to passively induced hypocapnia during NREM sleep in normal adult humans

1993 ◽  
Vol 75 (3) ◽  
pp. 1088-1096 ◽  
Author(s):  
S. T. Kuna ◽  
M. P. McCarthy ◽  
J. S. Smickley
Keyword(s):  
Vocal Cord ◽  
Spontaneous Breathing ◽  
Nrem Sleep ◽  
Normal Adult ◽  
Positive Pressure ◽  
Adductor Muscles ◽  
Posterior Cricoarytenoid Muscle ◽  
Adult Humans ◽  
Inspiratory Activity ◽  
Posterior Cricoarytenoid

Passively induced hypocapnia in animals activates vocal cord adductor muscles and decreases the glottic aperture. The purpose of this study was to determine if passively induced hypocapnia has similar effects in normal adult humans in stage 3/4 non-rapid-eye-movement (NREM) sleep. Hypocapnia was induced by hyperventilating the subjects with a positive-pressure ventilator via a nose mask. At hypocapnic levels below the CO2 apneic threshold, abrupt cessation of mechanical ventilation was followed by an apnea. In protocol 1, intramuscular electromyographic recordings of intrinsic laryngeal muscles were obtained in nine subjects. Activity of the posterior cricoarytenoid muscle, a vocal cord abductor, disappeared during passive hyperventilation. The muscle remained electrically silent during an apnea, but phasic inspiratory activity reappeared with the first respiratory effort. The thyroarytenoid and arytenoideus muscles, both vocal cord adductors, were electrically silent during spontaneous breathing in NREM sleep. Hypocapnia was frequently associated with activation of both adductor muscles. Once activated, the adductor muscles remained tonically active during an ensuring apnea. In protocol 2, a fiber-optic scope was advanced transnasally into the hypopharynx to determine glottic aperture size during passively induced hypocapnic apnea. In the seven subjects who achieved stable NREM sleep, the glottic aperture during an apnea was smaller than at any time throughout the respiratory cycle during spontaneous breathing just before positive-pressure ventilation. The results suggest that the decrease in glottic aperture observed during an induced hypocapnic apnea is due to suppression of the posterior cricoarytenoid muscle and/or activation of vocal cord adductor muscles.

Electrical Pacing of the Paralyzed Human Larynx

1996 ◽  
Vol 105 (9) ◽  
pp. 689-693 ◽  
Author(s):  
Cheryl L. Rainey ◽  
Garrett D. Herzon ◽  
David L. Zealear ◽  
James L. Netterville ◽  
Robert H. Ossoff
Keyword(s):  
Electrical Stimulation ◽  
Vocal Fold ◽  
Abductor Muscle ◽  
Spontaneous Movement ◽  
Normal Side ◽  
Posterior Cricoarytenoid Muscle ◽  
Human Larynx ◽  
Posterior Cricoarytenoid ◽  
Electrical Pacing ◽  
Stimulation Of

This study represents the first attempt to electrically pace the paralyzed human larynx. The goal was to determine if electrical stimulation of the posterior cricoarytenoid muscle could produce functional abduction of the vocal fold in pace with inspiration. An external apparatus was used to sense inspiration and reanimate the unilaterally paralyzed larynx of a thyroplasty patient. Stimuli were delivered through a needle electrode to locate and pace the abductor muscle. The magnitude of electrically induced abduction was comparable to spontaneous movement on the normal side. The abduction was appropriately timed with inspiration; this finding demonstrated that this simple pacing system could effectively modulate stimulation with patient respiration.

Laryngeal Synkinesis: Its Significance to the Laryngologist

1989 ◽  
Vol 98 (2) ◽  
pp. 87-92 ◽  
Author(s):  
Roger L. Crumley
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Basic Research ◽  
Laryngeal Electromyography ◽  
Bilateral Vocal Cord Paralysis ◽  
Laryngeal Function ◽  
Adductor Muscles ◽  
Posterior Cricoarytenoid Muscle ◽  
Posterior Cricoarytenoid ◽  
Intrinsic Laryngeal Muscles

Basic research and surgical cases have shown that the injured recurrent laryngeal nerve (RLN) may regenerate axons to the larynx that inappropriately innervate both vocal cord adductors and abductors. Innervation of vocal cord adductor muscles by those axons that depolarize during inspiration is particularly devastating to laryngeal function, since it produces medial vocal cord movement during inspiration. Many patients thought to have clinical bilateral vocal cord paralysis can be found to have synkinesis on at least one side. This will make the glottic airway smaller, particularly during inspiration, than would true paralysis of all the intrinsic laryngeal muscles. Patients with bilateral vocal cord paralysis should undergo laryngeal electromyography. If inspiratory innervation of the adductor muscles is present, simple reinnervation of the posterior cricoarytenoid muscle will fail. The adductor muscles also must be denervated by transection of the adductor division of the regenerated RLN.

Endoscopic Laser Medial Arytenoidectomy for Airway Management in Bilateral Laryngeal Paralysis

1993 ◽  
Vol 102 (2) ◽  
pp. 81-84 ◽  
Author(s):  
Roger L. Crumley
Keyword(s):  
Vocal Cord ◽  
Phrenic Nerve ◽  
Carbon Dioxide Laser ◽  
Recent Experience ◽  
Posterior Commissure ◽  
Laryngeal Paralysis ◽  
Nerve Transfers ◽  
Posterior Cricoarytenoid Muscle ◽  
Endoscopic Laser ◽  
Posterior Cricoarytenoid

A review of our recent experience in patients with bilateral laryngeal paralysis is described. While we continue to use phrenic nerve transfers in patients with mobile arytenoids, patients with fixed arytenoids generally require some sort of vocal cord lateralization, either by arytenoidectomy and arytenoidopexy or by partial vocal cord resection. The endoscopic laser medial arytenoidectomy is a convenient and effective method for opening the posterior glottic airway. One arytenoid is reduced medially with the carbon dioxide laser. After about 3 months the opposite arytenoid can be treated similarly, if necessary. The procedure does not appear to affect arytenoid mobility, as the posterior commissure mucosa and underlying interarytenoid muscle are protected and hence unaffected by the procedure. Those patients with at least one mobile arytenoid cartilage are candidates for posterior cricoarytenoid muscle reinnervation. Although ansa cervicalis and phrenic nerve techniques have been described, the author has concentrated efforts on the phrenic nerve. This report describes the endoscopic laser medial arytenoidectomy procedure, while the phrenic nerve patients will be reported in a subsequent manuscript.

Laryngeal influences on breathing pattern and posterior cricoarytenoid muscle activity

1985 ◽  
Vol 58 (4) ◽  
pp. 1298-1304 ◽  
Author(s):  
F. B. Sant'Ambrogio ◽  
O. P. Mathew ◽  
W. D. Clark ◽  
G. Sant'Ambrogio
Keyword(s):  
Breathing Pattern ◽  
Upper Airway ◽  
Airway Patency ◽  
Airway Occlusion ◽  
Laryngeal Nerves ◽  
Relative Contribution ◽  
Posterior Cricoarytenoid Muscle ◽  
Regulation Of Breathing ◽  
Anesthetized Dogs ◽  
Posterior Cricoarytenoid

Receptors responding to transmural pressure, airflow, and contraction of laryngeal muscles have been previously identified in the larynx. To assess the relative contribution of these three types of receptors to the reflex changes in breathing pattern and upper airway patency, we studied diaphragmatic (DIA) and posterior cricoarytenoid muscle (PCA) activity in anesthetized dogs during spontaneous breathing and occluded efforts with and without bypassing the larynx. Inspiratory duration (TI) was longer, mean inspiratory slope (peak DIA/TI) was lower, and PCA activity was greater with upper airway occlusion than with tracheal occlusion (larynx bypassed). Bilateral section of the superior laryngeal nerves eliminated these differences. When respiratory airflow was diverted from the tracheostomy to the upper airway the only change attributable to laryngeal afferents was an increase in PCA activity. These results confirm the importance of the superior laryngeal nerves in the regulation of breathing pattern and upper airway patency and suggest a prevalent role for laryngeal negative pressure receptors.

Phrenic Nerve Reinnervation of the Cat's Larynx: A New Technique with Proven Success

1993 ◽  
Vol 102 (11) ◽  
pp. 837-842 ◽  
Author(s):  
Patrick J. Doyle ◽  
Brian D. Westerberg ◽  
Douglas B. Chepeha ◽  
Dietrich W. F. Schwarz
Keyword(s):  
Vocal Cord ◽  
Fibrin Glue ◽  
Phrenic Nerve ◽  
Retrograde Labeling ◽  
Phrenic Motoneurons ◽  
Posterior Cricoarytenoid Muscle ◽  
Complete Failure ◽  
A New Technique ◽  
Posterior Cricoarytenoid ◽  
Nerve Trauma

Reinnervation of the posterior cricoarytenoid muscle (PCA) should provide vocal cord abduction on inspiration, and passive adduction to enable phonation. Previous investigators have shown that reinnervation is possible, but results have not been clinically encouraging. When reinnervation was successful, the question remained whether it was provided by the transplanted nerve or by the ingrowth of adjacent nerves. In this study the phrenic nerve was transplanted directly into the PCA in a series of 12 cats. Fibrin glue was used to overcome nerve trauma and to prevent retraction of the nerve from the PCA. Laryngoscopy, electromyography, and retrograde labeling of the phrenic motoneurons provided evidence of functional reinnervation in 9 cats. Partial or complete failure in the remaining 3 was due to retraction of the nerve from the muscle. These results appear to justify trials of the procedure in humans.

Delayed Reinnervation of Unilateral Vocal Cord Paralysis in Dogs

1981 ◽  
Vol 89 (4) ◽  
pp. 608-612 ◽  
Author(s):  
G. David Neal ◽  
Charles W. Cummings ◽  
Dwight Sutton
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Histologic Examination ◽  
Implantation Technique ◽  
Posterior Cricoarytenoid Muscle ◽  
Chronic Denervation ◽  
Posterior Cricoarytenoid ◽  
Unilateral Vocal Cord Paralysis

The neuromuscular implantation technique for rehabilitation of unilateral vocal cord paralysis was performed in four dogs at the time of denervation and in six dogs after varying intervals of chronic denervation. As would be expected, the chronically denervated animals did not achieve the vocal cord excursion of the acute denervations, but some return of motion was noted even after six months. Histologic examination of the posterior cricoarytenoid muscle was correlated with the return of movement.

Sign in / Sign up

Export Citation Format

Share Document