From the Guidelines
Laryngeal reinnervation is primarily indicated for unilateral vocal fold paralysis that has persisted beyond 6-12 months without spontaneous recovery, particularly in younger patients with good overall health status. This recommendation is based on the understanding that reinnervation procedures aim to restore vocal fold function and improve voice quality in a more permanent manner compared to other rehabilitative options like voice therapy or injection laryngoplasty 1.
Key Considerations for Laryngeal Reinnervation
- The procedure is suitable for patients with a healthy contralateral vocal fold and good general health, as these factors contribute to better outcomes and reduced complications.
- Ideal candidates should have realistic expectations about voice outcomes and understand the timeline for nerve regeneration and functional improvement, which can take up to a year 1.
- Laryngeal reinnervation is particularly beneficial for patients who have not responded well to or are not candidates for other treatments such as injection laryngoplasty or medialization thyroplasty, as it offers a potential for restoring more natural vocal fold function.
Comparison with Other Treatments
- Voice therapy can offer temporary or permanent improvement in voice quality through adjustment and compensation to altered laryngeal physiology, but it may not address the underlying paralysis as directly as reinnervation 1.
- Injection laryngoplasty provides temporary restoration of vocal fold position and bulk but may need to be repeated, whereas reinnervation aims for a more permanent solution 1.
- Framework procedures can also restore vocal fold position permanently but may not address the neural component of vocal fold paralysis as reinnervation does 1.
Important Notes
- The final surgical outcome of laryngeal reinnervation can take up to a year, and true restoration of physiologic reinnervation is not achievable, but it can significantly improve voice quality and reduce the need for future interventions 1.
- A vocal fold injection is typically performed at the same time as reinnervation to rehabilitate voice during the healing period, highlighting the complementary nature of these procedures in achieving optimal voice outcomes 1.
From the Research
Indications for Laryngeal Reinnervation
Laryngeal reinnervation is a surgical technique used to restore laryngeal function in patients with vocal fold paralysis. The indications for this procedure include:
- Bilateral vocal fold paralysis (BVFP) to achieve good airway and preserve voice quality 2
- Unilateral vocal fold paralysis (UVFP) to improve voice quality and stability 3, 4, 5, 6
- Patients with severe denervation and unsuccessful medialization 3
- Patients with high expectations concerning voice quality 3
Surgical Techniques
Different surgical techniques are used for laryngeal reinnervation, including:
- Nonselective reinnervation, which involves anastomosis to the mainstem of the recurrent laryngeal nerve (RLN) 4
- Selective reinnervation, which involves separate target muscle reinnervation of the abductor and/or adductor muscles 4
- Ansa cervicalis-recurrent laryngeal nerve anastomosis (RLN) 5
- Nerve implantation of the thyroarytenoid muscle with the ansa cervicalis 5
- Modified nerve-muscle pedicle reinnervation 6
Patient Selection
Careful selection of the appropriate candidate is crucial for a successful procedure 5. Patients with valuable voices, such as professional singers, actors, and public speakers, may benefit from laryngeal reinnervation 6. A minimum period of 12 months after onset of paralysis is recommended to allow for possible spontaneous reinnervation or compensation 5.