Selective Section of the Recurrent Laryngeal Nerve for the Treatment of Spastic Dysphonia: An Experimental Study and Preliminary Clinical Report

1981 ◽  
Vol 89 (6) ◽  
pp. 986-991 ◽  
Author(s):  
Robert J. Carpenter ◽  
G. Gordon Snyder ◽  
Julian L. Henley-Cohn
Keyword(s):  
Experimental Study ◽  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Clinical Results ◽  
Laryngeal Nerve ◽  
Clinical Report ◽  
Nerve Section ◽  
Vocal Cord Motion

The experimental and clinical results of the surgical treatment of patients with spastic dysphonia by selective section of the adductor branch of the recurrent laryngeal nerve are described. Experimental selective nerve section in dogs appears to retain cordal abduction during inspiration while producing a partial adductor paralysis. Selective section of the recurrent laryngeal nerve has been performed in four patients with 18- to 24-month follow-up. Speech results have been good with maintenance of partial vocal cord motion. No patient has experienced a return of spasticity. We theorize that selective nerve section may decrease the likelihood of the long-term failure that has been seen with complete nerve section by preventing medial fixation of the paralyzed vocal cord.

Short- and Long-Term Results of Total vs Subtotal Thyroid- ectomies in the Surgical Treatment of Graves' Disease

Swiss Surgery ◽  
2001 ◽  
Vol 7 (1) ◽  
pp. 20-24 ◽  
Author(s):  
Robert ◽  
Mariéthoz ◽  
Pache ◽  
Bertin ◽  
Caulfield ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Laryngeal Nerve ◽  
Long Term Results ◽  
Graves Disease ◽  
Laryngeal Nerve Palsy ◽  
Short And Long Term

Objective: Approximately one out of five patients with Graves' disease (GD) undergoes a thyroidectomy after a mean period of 18 months of medical treatment. This retrospective and non-randomized study from a teaching hospital compares short- and long-term results of total (TT) and subtotal thyroidectomies (ST) for this disease. Methods: From 1987 to 1997, 94 patients were operated for GD. Thirty-three patients underwent a TT (mostly since 1993) and 61 a ST (keeping 4 to 8 grams of thyroid tissue - mean 6 g). All patients had received propylthiouracil and/or neo-mercazole and were in a euthyroid state at the time of surgery; they also took potassium iodide (lugol) for ten days before surgery. Results: There were no deaths. Transient hypocalcemia (< 3 months) occurred in 32 patients (15 TT and 17 ST) and persistent hypocalcemia in 8 having had TT. Two patients developed transient recurrent laryngeal nerve palsy after ST (< 3 months). After a median follow-up period of seven years (1-15) with five patients lost to follow-up, 41 patients having had a ST are in a hypothyroid state (73%), thirteen are euthyroid (23%), and two suffered recurrent hyperthyroidism, requiring completion of thyroidectomy. All 33 patients having had TT - with follow-ups averaging two years (0.5-8) - are receiving thyroxin substitution. Conclusions: There were no instances of persistent recurrent laryngeal nerve palsy in either group, but persistent hypoparathyroidism occurred more frequently after TT. Long after ST, hypothyroidism developed in nearly three of four cases, whereas euthyroidy was maintained in only one-fourth; recurrent hyperthyroidy was rare.

Adductor Spastic Dysphonia: 1 1/2 Years after Recurrent Laryngeal Nerve Resection

1981 ◽  
Vol 90 (1) ◽  
pp. 2-6 ◽  
Author(s):  
Arnold E. Aronson ◽  
Lawrence W. DeSanto
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Physical Effort ◽  
Patients Âgés ◽  
Reduced Volume ◽  
Follow Up Studies ◽  
Long Term Follow Up ◽  
Selection Of

After recurrent laryngeal nerve resection for adductor spastic dysphonia, the voices of 37 patients (ages 39 to 79 years) were assessed 24 hours, 1 month, 6 months, and 1 year after surgery, and those of 33 patients up to 1 1/2 years after surgery. By 24 hours after surgery, 97% of patients had improved and 3% had failed; by 1 month, 97% were still improved while 3% had failed; by 6 months, 92% had maintained improvement while 8% had failed; by 1 year, 68% were still improved but 32% had failed; and by 1 1/2 years, 61% were still improved while 39% had failed. The patients whose voices improved varied from one another in both type and degree of residual dysphonia. The typical postsurgical voice was free of spasm, with some breathiness, hoarseness, and reduced volume being present. The voices of some patients approached normalcy. To most patients, relief from the physical effort to phonate was as important as the improved voice. Continued long-term follow-up studies and careful, collaborative selection of surgical candidates are needed.

Laryngeal Nerve Crush for Spastic Dysphonia

1979 ◽  
Vol 88 (4) ◽  
pp. 531-532 ◽  
Author(s):  
Hugh F. Biller ◽  
Max L. Som ◽  
William Lawson
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Laryngeal Nerve ◽  
Nerve Crush ◽  
Vocal Cord Motion

Four patients with spastic dysphonia refractory to speech and phychiatric therapy were treated by crushing the recurrent laryngeal nerve. Vocal cord paralysis was produced in all patients. Vocal spasticity subsided in all patients. Vocal cord motion returned in four to six months. Three of four patients remained free of spasticity for a minimum of 24 months.

Long-Term Follow-up of Recurrent Laryngeal Nerve Avulsion for the Treatment of Spastic Dysphonia

1996 ◽  
Vol 105 (8) ◽  
pp. 592-601 ◽  
Author(s):  
Brian S. Jewett ◽  
R. E. Stone ◽  
Donald T. Weed ◽  
Cheryl Rainey ◽  
Robert H. Ossoff ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Nerve Stump ◽  
Self Assessment ◽  
Long Term Follow Up ◽  
Histologic Evaluation ◽  
Distal Nerve ◽  
Medialization Laryngoplasty

Long-term follow-up of 3 to 7 years is reported on 18 patients who had undergone recurrent laryngeal nerve avulsion (RLNA) for the treatment of adductor spastic dysphonia (SD). Data on neural regrowth after previous recurrent laryngeal nerve section (RLNS) are presented in 2 of these 18 patients. We introduced RLNA as a modification of standard RLNS to prevent neural regrowth to the hemiparalyzed larynx and subsequent recurrence of SD. We have treated a total of 22 patients with RLNA, and now report a 3- to 7-year follow-up on 18 of these 22 patients. Resolution of symptoms was determined by routine follow-up assessment, perceptual voice analysis, and patient self-assessment Sixteen of 18, or 89%, had no recurrence of spasms at 3 years after RLNA as determined at routine follow-up. Two of the 16 later developed spasms after medialization laryngoplasty for treatment of weak voice persistent after the avulsion. This yielded a total of 14 of 18, or 78%, who were unanimously judged by four speech pathologists to have no recurrence of SD at the longer follow-up period of 3 to 7 years. Two of these 4 patients were judged by all four analysts to have frequent, short spasms. The other 2 were judged by two of four analysts to have seldom, short spasms. Three of 18 patients presented with recurrent SD after previous RLNS. At the time of subsequent RLNA, each patient had evidence of neural regrowth at the distal nerve stump as demonstrated by intraoperative electromyography and histologic evaluation of the distal nerve stump. One remained free of SD following RLNA, 1 was free of spasms at 4 years after revision avulsion but developed spasms after medialization laryngoplasty, and the final patient developed spasms 3.75 years after revision RLNA. Medialization laryngoplasty with Silastic silicone rubber was performed in 6 of 18, with correction of postoperative breathiness in all 6, but with recurrence of spasm in 3. Spasms resolved in 1 of these with downsizing of the implant. We conclude that RLNA represents a useful treatment in the management of SD in patients not tolerant of botulinum toxin injections.

Postoperative and Follow-up Studies of Spastic Dysphonia Patients Treated by Recurrent Laryngeal Nerve Section

1981 ◽  
Vol 89 (1) ◽  
pp. 96-101 ◽  
Author(s):  
Krzysztof Izdebski ◽  
Herbert H. Dedo ◽  
Thomas Shipp ◽  
Richard M. Flower
Keyword(s):  
Surgical Treatment ◽  
Subjective Assessment ◽  
Laryngeal Nerve ◽  
Long Term Results ◽  
Nerve Section ◽  
Psychophysical Scaling ◽  
Follow Up Studies ◽  
Long Term Follow Up

Long-term results of surgical treatment of spastic dysphonia by RLN section are evaluated by means of perceptual psychophysical scaling and by the patients themselves. It is found that a significant reduction in spastic dysphonia symptoms occurs as a result of surgery, and that these results are maintained after long-term follow-up in the majority of patients. These experimental observations are in agreement with the subjective assessment of postsurgical communication by the patients involved in the study.

scholarly journals Neuromonitoring of the Recurrent Laryngeal Nerve Reduces the Rate of Bilateral Vocal Cord Dysfunction in Planned Bilateral Thyroid Procedures

2021 ◽  
Vol 10 (4) ◽  
pp. 740
Author(s):  
Constantin Smaxwil ◽  
Miriam Aleker ◽  
Julia Altmeier ◽  
Ali Naddaf ◽  
Mirjam Busch ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Intraoperative Neuromonitoring ◽  
Laryngeal Nerve ◽  
Vocal Cord Dysfunction ◽  
Tertiary Referral ◽  
Bilateral Surgery ◽  
Transient Loss ◽  
Staged Operations

Purpose: Bilateral vocal cord dysfunction (bVCD) is a rare but feared complication of thyroid surgery. This long term retrospective study determined the effect of intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) during thyroid surgeries with regard to the rate of bVCD and evaluated the frequency as well as the outcome of staged operations. Methods: Retrospective analysis of prospectively documented data (2000–2019) of a tertiary referral centers’ database. IONM started in 2000 and, since 2010, discontinuation of surgery was encouraged in planned bilateral surgeries to prevent bVCD, if non-transient loss of signal (ntLOS) occurred on the first side. Datasets of the most recent 40-month-period were assessed in detail to determine the clinical outcome of unilateral ntLOS in planned bilateral thyroid procedures. Results: Of 22,573 patients, 65 had bVCD (0.288%). The rate of bVCD decreased from 0.44 prior to 2010 to 0.09% after 2010 (p < 0.001, Chi2). Case reviews of the most recent 40 months period identified ntLOS in 113/3115 patients (3.6%, 2.2% NAR), of which 40 ntLOS were recorded during a planned bilateral procedure (n = 952, 2.1% NAR). Of 21 ntLOS occurring on the first side of the bilateral procedure, 15 procedures were stopped, subtotal contralateral resections were performed, and thyroidectomy was continued in 3 patients respectively, with the use of continuous vagal IONM. Eighteen cases of VCD were documented postop, and all but one patient had a full recovery. Seven patients had staged resections after 1 to 18 months (median 4) after the first procedure. Conclusion: IONM facilitates reduced postoperative bVCD rates. IONM is, therefore, recommendable in planned bilateral procedures. The rate of non-complete bilateral surgery after intraoperative non-transient LOS was 2%.

Preservation of the Laryngeal Nerves during Total Thyroid Lobectomy

1977 ◽  
Vol 86 (6) ◽  
pp. 777-788 ◽  
Author(s):  
John M. Loré ◽  
Duck J. Kim ◽  
Samir Elias
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Vocal Cord ◽  
Superior Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Parathyroid Glands ◽  
External Branch ◽  
Thyroid Lobectomy ◽  
Maximum Protection

A technique of exposure and preservation of the recurrent laryngeal nerve at the very onset of thyroidectomy and preservation of the external branch of the superior laryngeal nerve at the close of the procedure is described, which is believed to afford maximum protection to these nerves during total thyroid lobectomy and isthmusectomy as well as total thyroidectomy. At the same time, preservation of the parathyroid glands is achieved. In 120 exposures and preservations of the recurrent laryngeal nerve there have been no instances of a single permanent paralysis of this nerve. In 111 total thyroid lobectomies in which the external branch of the superior laryngeal nerve was placed in jeopardy, only one patient had a slight bowing of the vocal cord with excellent voice function during a limited follow-up period.

Treatment of Spastic Dysphonia without Nerve Section

1987 ◽  
Vol 96 (5) ◽  
pp. 590-596 ◽  
Author(s):  
Michael Friedman ◽  
Vytenis Grybauskas ◽  
Dean M. Toriumi ◽  
Edward L. Applebaum
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Stimulus Frequency ◽  
Laryngeal Nerve ◽  
Dramatic Improvement ◽  
Nerve Section ◽  
Cuff Electrode ◽  
Minimal Improvement ◽  
Term Basis ◽  
Stimulation System

Spastic dysphonia is a disorder characterized by strained, constricted phonation with excessively adducted vocal cords. Despite initial success with recurrent laryngeal nerve section, the search for other treatment continues. Our clinical study involved inserting a needle electrode percutaneously into the region of the recurrent laryngeal nerve in five patients with spastic dysphonia. Electrical stimulation resulted in dramatic improvement in three patients and minimal improvement in two. Our experimental study was designed to create an animal model for an implantable nerve stimulator to be used on a long-term basis. A Medtronic spinal cord stimulation system was implanted into a dog, and a cuff electrode was positioned around the recurrent laryngeal nerve. Vocal cord position could be altered by varying the stimulus frequency. Long-term stimulation of the recurrent laryngeal nerve was relatively safe and effective. Eventually, we plan to implant nerve stimulators into spastic dysphonia patients who respond well to percutaneous stimulation.

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