Non-selective unilateral laryngeal reinnervation in unilateral vocal cord paralysis: An evaluation of phoniatric long-term results of 47 patients

Introduction:

Non-selective unilateral laryngeal reinnervation (ULR) is the surgical anastomosis of the recurrent laryngeal nerve (RLN) with a further cervical nerve. We present results concerning the voice quality of 47 patients on whom non-selective ULR was performed.

Methods:

47 patients with unilateral laryngeal paralysis were included in this monocentric, prospective study. In all cases ansa cervicalis-to-RLN anastomosis technique was applied in combination with vocal cord augmentation of the paralytic side using autologous material (fat). Evaluation included voice quality questionnaire (Rouen Voice Questionnaire (RVQ): 0 – 140), perceptual analysis using Hirano's GRBAS-scale and computerized phoniatric evaluation (shimmer, jitter, maximal phonation time (mpt) in seconds (s), maximal intensity in (dB)) pre- and postoperative after 1 – 3, 12 or more months (m).

Results:

An increase in mean self-evaluated voice quality was observed (RVQ: pre: 97.3, 1 – 3 m: 61.9, 36 m: 19.7 (p < 0.001)). Digitally assessed phonation data showed improved voice quality (jitter: pre: 13.7, 1 – 3 m: 4.8, 12 m: 1.3 (p =.003); shimmer: pre: 1.4, 1 – 3 m: 1.24, 12 m: 0.4 (p<.001)). Maximal phonation time (s) and maximal voice intensity (dB) increased (mpt: pre: 6.98, 1 – 3 m: 7.62; 12 m: 12.71 (p<.001); max. intensity: pre: 88.8 1 – 3 m: 89.7, 12 m: 95.48 (p<.001)). An improvement of externally assessed voice quality (perceptual analysis) over time was observed.

Conclusion:

Non-selective unilateral laryngeal reinnervation in unilateral vocal cord paralysis is a reliable and stable therapeutic option for patients with high expectations concerning voice quality. We attribute direct voice quality improvement to vocal cord augmentation and further voice improvement over time to the effect of axonal regrowth.

Publication History

Publication Date:
18 April 2018 (online)