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.
