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Isabella AJ, Moens CB. Development and regeneration of the vagus nerve. Semin Cell Dev Biol 2024; 156:219-227. [PMID: 37537116 PMCID: PMC10830892 DOI: 10.1016/j.semcdb.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 07/13/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
The vagus nerve, with its myriad constituent axon branches and innervation targets, has long been a model of anatomical complexity in the nervous system. The branched architecture of the vagus nerve is now appreciated to be highly organized around the topographic and/or molecular identities of the neurons that innervate each target tissue. However, we are only just beginning to understand the developmental mechanisms by which heterogeneous vagus neuron identity is specified, patterned, and used to guide the axons of particular neurons to particular targets. Here, we summarize our current understanding of the complex topographic and molecular organization of the vagus nerve, the developmental basis of neuron specification and patterned axon guidance that supports this organization, and the regenerative mechanisms that promote, or inhibit, the restoration of vagus nerve organization after nerve damage. Finally, we highlight key unanswered questions in these areas and discuss potential strategies to address these questions.
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Affiliation(s)
- Adam J Isabella
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Cecilia B Moens
- Basic Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA 98109, USA.
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2
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Fernandes ACN, Ferreira MVN, Serra LM, da Silva EM, Sampaio AL, Kuckelhaus SAS. Methodological Approaches for Vocal Folds Experiments in Laryngology: A Scoping Review. J Voice 2022:S0892-1997(22)00227-2. [PMID: 36137879 DOI: 10.1016/j.jvoice.2022.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The aim of this study was to describe the methodological approaches adopted in experimental researches in laryngology intervention studies. METHODS The study was performed as a scoping review using the electronic databases Medline (PubMed), Web of Science, Embase, BioMed Central and SCOPUS. These databases were manually searched from 1995 (or its inception) until the most recently published articles in June 2022. The inclusion criteria were as follows: a) studies performed with animal models in voice and/or larynx therapy, intervention and/or surgery; b) studies with participant populations composed with animals; c) studies containing original research; d) studies performed with at least one objective measurement for treatment and or intervention; e) studies reporting at least one method of larynx intervention; and f) publications written in English, Spanish or Portuguese. The exclusion criteria were as follows: a) studies considering without any objective intervention and or treatment; b) studies without animal models; and c) studies that reviewed articles or books. These criteria were set to increase inter-study comparability. RESULTS There were found 26 studies that showed that in experimental laryngology. There were retrieved four main characteristics in the retrieved studies. It was observed five major groups of experimental models used for assessing vocal folds: dog (38.5%), rat/mouse (23,1%), pig (23.1%), rabbit (19.2%), human (11.5%), and sheep (3.8%). In addition, three characteristics were observed: sample (up to 20 subjects 88.5%), type of surgery/intervention (100%) and duration (up to 30 days 61.5%). CONCLUSION In experimental laryngology, the state of the art is grounded on mainly in dog, rat and pig in vocal folds assessment. Up to 20 subjects, surgery/intervention and experimental trial lasting no more than 30 days are frequent methodological approaches in this research field.
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Affiliation(s)
- Ana Carolina Nascimento Fernandes
- Laboratory of Teaching and Research in Otorhinolaryngology, Faculty of Medicine, University of Brasília-UnB - Darcy Ribeiro University Campus.
| | - Marcus Vinícius Nascimento Ferreira
- HEALth, pHYsical activity and Behavior ReseArch (HEALTHY-BRA) group, Universidade Federal do Tocantins, Tocantins, Brazil; Youth/Child Cardiovascular Risk and Environmental (YCARE) Research Group, School of Medicine, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
| | - Lucieny Martins Serra
- Laboratory of Teaching and Research in Otorhinolaryngology, Faculty of Medicine, University of Brasília-UnB - Darcy Ribeiro University Campus
| | | | - André Luis Sampaio
- Speech Language-Pathology Course, University of Brasília, Faculdade de Ceilândia, Brasília / DF, Brazil
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Ridgway C, Bouhabel S, Martignetti L, Kishimoto Y, Li-Jessen NYK. Pediatric Vocal Fold Paresis and Paralysis: A Narrative Review. JAMA Otolaryngol Head Neck Surg 2021; 147:745-752. [PMID: 34110365 DOI: 10.1001/jamaoto.2021.1050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Vocal fold paralysis (VFP) results from the disruption of neural motor outputs to laryngeal muscles. Children with VFP manifest various degrees of difficulties in phonation, breathing, and swallowing. Although the etiologic characteristics and symptoms of VFP are well established in adults, corresponding clinical profiles are notably different in children. Clinical management of VFP is particularly challenging in children because their larynges are still actively developing and the recovery of disrupted laryngeal nerves is often unpredictable. This review discusses the neurologic conditions and diagnostic and treatment considerations in pediatric VFP. Observations Injury to the peripheral laryngeal nerves and certain central nervous system diseases, such as Arnold-Chiari malformation type II, can result in VFP in infants and children. The incidence of unilateral vs bilateral VFP is variable across pediatric studies. Most reported VFP cases are associated with injury of the recurrent laryngeal nerve. Laryngeal electromyography requires needle insertion that must be performed under anesthesia with special care in the pediatric setting. Neither normative values nor standardized procedures of laryngeal electromyography are currently established for the pediatric population. Laryngeal reinnervation, endoscopic arytenoid abduction lateropexy, and laryngeal pacing are plausible treatment options for pediatric VFP. Despite these new advances in the field, no corresponding efficacy data are available for clinicians to discern which type of patients would be the best candidates for these procedures. Conclusions and Relevance The neuroanatomy and neurophysiology of VFP remain more elusive for the pediatric population than for adults. Basic and clinical research is warranted to fully comprehend the complexity of this laryngeal movement disorder and to better inform and standardize clinical practice.
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Affiliation(s)
- Chelsea Ridgway
- School of Communication Sciences and Disorders, McGill University, Montreal, Canada
| | - Sarah Bouhabel
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Canada
| | - Lisa Martignetti
- School of Communication Sciences and Disorders, McGill University, Montreal, Canada
| | - Yo Kishimoto
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University, Kyoto, Japan
| | - Nicole Y K Li-Jessen
- School of Communication Sciences and Disorders, McGill University, Montreal, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Canada.,Department of Biomedical Engineering, McGill University, Montreal, Canada
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Xie Y, Schneider KJ, Ali SA, Hogikyan ND, Feldman EL, Brenner MJ. Current landscape in motoneuron regeneration and reconstruction for motor cranial nerve injuries. Neural Regen Res 2020; 15:1639-1649. [PMID: 32209763 PMCID: PMC7437597 DOI: 10.4103/1673-5374.276325] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 10/31/2019] [Accepted: 12/23/2019] [Indexed: 12/16/2022] Open
Abstract
The intricate anatomy and physiology of cranial nerves have inspired clinicians and scientists to study their roles in the nervous system. Damage to motor cranial nerves may result from a variety of organic or iatrogenic insults and causes devastating functional impairment and disfigurement. Surgical innovations directed towards restoring function to injured motor cranial nerves and their associated organs have evolved to include nerve repair, grafting, substitution, and muscle transposition. In parallel with this progress, research on tissue-engineered constructs, development of bioelectrical interfaces, and modulation of the regenerative milieu through cellular, immunomodulatory, or neurotrophic mechanisms has proliferated to enhance the available repertoire of clinically applicable reconstructive options. Despite these advances, patients continue to suffer from functional limitations relating to inadequate cranial nerve regeneration, aberrant reinnervation, or incomplete recovery of neuromuscular function. These shortfalls have profound quality of life ramifications and provide an impetus to further elucidate mechanisms underlying cranial nerve denervation and to improve repair. In this review, we summarize the literature on reconstruction and regeneration of motor cranial nerves following various injury patterns. We focus on seven cranial nerves with predominantly efferent functions and highlight shared patterns of injuries and clinical manifestations. We also present an overview of the existing reconstructive approaches, from facial reanimation, laryngeal reinnervation, to variations of interposition nerve grafts for reconstruction. We discuss ongoing endeavors to promote nerve regeneration and to suppress aberrant reinnervation and the development of synkinesis. Insights from these studies will shed light on recent progress and new horizons in understanding the biomechanics of peripheral nerve neurobiology, with emphasis on promising strategies for optimizing neural regeneration and identifying future directions in the field of motor cranial neuron research.
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Affiliation(s)
- Yanjun Xie
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kevin J. Schneider
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Syed A. Ali
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Norman D. Hogikyan
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Eva L. Feldman
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michael J. Brenner
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA
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Christakis I, Klang P, Talat N, Galata G, Schulte KM. Long-term quality of voice is usually acceptable after initial hoarseness caused by a thyroidectomy or a parathyroidectomy. Gland Surg 2019; 8:226-236. [PMID: 31328101 DOI: 10.21037/gs.2018.09.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Vocal cord (VC) palsy following a thyroidectomy or parathyroidectomy can result in significant morbidity for the patient. We aimed to investigate the incidence of VC palsy in a tertiary referral Institution, track the management of these cases and record the long-term outcomes and VC recovery rates. Methods Retrospective review of all thyroidectomy/parathyroidectomy operations performed over 11 years. Patients with an unequivocal hoarse voice postoperatively were included. We analysed the patient's clinical characteristics and voice outcomes, operative, pathology and laryngoscopy reports during their follow-up. Results Ten patients fitted the inclusion criteria and were analysed. Median age at date of operation was 47.5 years (range, 16-81 years) and the M:F ratio was 1:2.3 (M:3, F:7). The median FU was 62.5 months (range, 12-144 months). The median hospital stay was 1.5 days (range, 1-87 days). There were 7 recurrent laryngeal nerve (RLN) injuries by manipulation, 1 case of RLN resection, 1 inadvertent division (with primary nerve repair) and 1 RLN was shaved off the thyroid. Long-term voice outcomes for the 7 patients with an RLN manipulation injury were: 3/7 patients had normal voice, 3/7 had moderate hoarseness and 1/7 had long-term hoarseness. The long-term voice outcome of the patient with RLN shaving off the thyroid gland was excellent while the 2 remaining patients (RLN resection and inadvertent division) needed 12 and 18 months respectively to achieve a normal quality of voice. Four out of the 10 patients had permanent VC palsy in the long-term and their voice outcomes varied: 1 patient had a normal voice, 2 patients had moderate hoarseness and 1 patient had persistent hoarseness. Only 1/10 patients did not show any voice improvement after 12 months. Conclusions In the vast majority of cases post-operative hoarseness due to RLN palsy improves in the long-term, albeit voice may not return completely to normal.
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Affiliation(s)
- Ioannis Christakis
- Department of Endocrine Surgery, King's College Hospital NHS Foundation Trust, Brixton, London, UK
| | - Patrick Klang
- Department of Endocrine Surgery, King's College Hospital NHS Foundation Trust, Brixton, London, UK
| | - Nadia Talat
- Department of Endocrine Surgery, King's College Hospital NHS Foundation Trust, Brixton, London, UK
| | - Gabriele Galata
- Department of Endocrine Surgery, King's College Hospital NHS Foundation Trust, Brixton, London, UK
| | - Klaus-Martin Schulte
- Department of Endocrine Surgery, King's College Hospital NHS Foundation Trust, Brixton, London, UK
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Gazzaz M, Saini J, Pagliardini S, Tsui B, Jeffery C, El-Hakim H. Comparison of inhaled versus intravenous anesthesia for laryngoscopy and laryngeal electromyography in a rat model. J Otolaryngol Head Neck Surg 2018; 47:64. [PMID: 30342558 PMCID: PMC6196000 DOI: 10.1186/s40463-018-0312-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 10/05/2018] [Indexed: 12/26/2022] Open
Abstract
Background Propofol and remifentanil intravenous combination is one popular form of total intravenous anesthesia (TIVA) in mainstream clinical practice, but it has rarely been applied to a rat model for laryngoscopy and laryngeal electromyography (LEMG). Our objective was to establish a safe and reproducible general anesthetic protocol for laryngoscopy and endoscopic LEMG in a rat model. Our hypothesis is that TIVA allows a minimally morbid, and feasible laryngoscopy and LEMG. Methods Sprague Dawley rats were subjected to either inhalational anesthesia (IA) (isoflurane) or TIVA (propofol and remifentanil) and underwent laryngoscopy and LEMG. The primary outcome was a complete minimally interrupted rigid laryngoscopy and obtaining reproducible motor unit potentials from the posterior cricoarytenoid muscles. The secondary outcome was morbidity and mortality. Results Seventeen out of twenty-two rats underwent both TIVA and IA. Only two underwent IA only. All nineteen rats that underwent IA had a successful experiment. Seventeen rats underwent TIVA, however, only nine completed a successful experiment due to difficulty achieving a surgical plane, and respiratory events. Upon comparing the success of the two anaesthetic regimens, IA was superior to TIVA (P = 0.0008). There was no statistical difference between the amplitudes (p = 0.1985) or motor units burst duration (p = 0.82605) of both methods. Three mortalities were encountered, one of which was due to lidocaine toxicity and two were during anesthetic induction. Respiratory related morbidity was encountered in two rats, all seen with TIVA. Conclusions TIVA is not an ideal anesthetic regimen for laryngeal endoscopy and LEMG in rat models. Contrary to our hypothesis, IA did not affect the quality of the LEMG and allowed a seamless rigid endoscopy. Electronic supplementary material The online version of this article (10.1186/s40463-018-0312-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Gazzaz
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, 2C3.57 Walter MacKenzie Centre, Edmonton, AB, T6G 2R7, Canada.
| | - J Saini
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada.,Women and Children Research Institute, University of Alberta, Edmonton, AB, Canada
| | - S Pagliardini
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada.,Women and Children Research Institute, University of Alberta, Edmonton, AB, Canada.,Department of Physiology, University of Alberta, Edmonton, AB, Canada
| | - B Tsui
- Stanford University Pediatric Regional Anesthesia, Stanford University, Stanford, California, USA
| | - C Jeffery
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, 2C3.57 Walter MacKenzie Centre, Edmonton, AB, T6G 2R7, Canada
| | - H El-Hakim
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Alberta, 2C3.57 Walter MacKenzie Centre, Edmonton, AB, T6G 2R7, Canada
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Araki K, Suzuki H, Uno K, Tomifuji M, Shiotani A. Gene Therapy for Recurrent Laryngeal Nerve Injury. Genes (Basel) 2018; 9:E316. [PMID: 29941853 PMCID: PMC6071248 DOI: 10.3390/genes9070316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 06/20/2018] [Indexed: 11/23/2022] Open
Abstract
Recurrent laryngeal nerve (RLN) injury has considerable clinical implications, including voice and swallowing dysfunction, which may considerably impair the patient’s quality of life. Recovery of vocal fold movement is an essential novel treatment option for RLN injury. The potential of gene therapy for addressing this issue is highly promising. The target sites for RLN gene therapy are the central nervous system, nerve fibers, laryngeal muscles, and vocal cord mucosa. Gene transduction has been reported in each site using viral or non-viral methods. The major issues ensuing after RLN injury are loss of motoneurons in the nucleus ambiguus, degeneration and poor regeneration of nerve fibers and motor end plates, and laryngeal muscle atrophy. Gene therapy using neurotrophic factors has been assessed for most of these issues, and its efficacy has been reported. Another important matter for functional vocal fold movement recovery is misdirected regeneration, in which the wrong neurons may innervate other laryngeal muscles, where even if innervation is reestablished, proper motor function is not restored. Novel strategies involving gene therapy bear promise for overcoming this issue and further investigations are underway.
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Affiliation(s)
- Koji Araki
- Department of Otolaryngology-Head & Neck Surgery, National Defense Medical College, Saitama 3598513, Japan.
| | - Hiroshi Suzuki
- Department of Otolaryngology-Head & Neck Surgery, National Defense Medical College, Saitama 3598513, Japan.
| | - Kosuke Uno
- Department of Otolaryngology-Head & Neck Surgery, National Defense Medical College, Saitama 3598513, Japan.
| | - Masayuki Tomifuji
- Department of Otolaryngology-Head & Neck Surgery, National Defense Medical College, Saitama 3598513, Japan.
| | - Akihiro Shiotani
- Department of Otolaryngology-Head & Neck Surgery, National Defense Medical College, Saitama 3598513, Japan.
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Kashlan ON, Kashlan BN, Oh SS, McGinley LM, Chen KS, Kupfer R, Erman A, Sakowski SA, Feldman EL. Histological Bulbar Manifestations in the ALS Rat. NEURODEGENER DIS 2015; 15:121-6. [PMID: 25825172 DOI: 10.1159/000377725] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/04/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Almost all patients with amyotrophic lateral sclerosis (ALS) develop bulbar symptoms; therefore, it is important to have valid animal models that accurately reflect these features. While the SOD1-G93A rat is extensively used as an ALS model, bulbar symptoms in this model are not well characterized. OBJECTIVE In the present study, we aimed to better characterize bulbar dysfunction in terms of histology to determine whether the SOD1-G93A rat is a useful model for bulbar-onset ALS. METHODS Sixty-day-old SOD1-G93A rats on a Sprague-Dawley background and age-matched wild-type controls were assessed weekly for global motor function, facial nerve function, and vagal nerve function. The study endpoint was determined when an SOD1-G93A rat could not right itself within 30 s of being placed on its side. At that point, neuronal counts were assessed in different brainstem cranial nerve nuclei. In addition, the masseter muscle, posterior belly of the digastric muscle, and tongue muscle were evaluated for intact neuromuscular junctions. RESULTS Our data demonstrate decreases in the number of motor neurons in the trigeminal, facial, and hypoglossal nuclei, as well as compromised neuromuscular junction integrity in the muscles they innervate. CONCLUSION These findings suggest that, from a histological standpoint, the SOD1-G93A rat is a valid model of ALS bulbar symptoms.
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Affiliation(s)
- Osama N Kashlan
- Department of Neurosurgery, University of Michigan, Ann Arbor, Mich., USA
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Paniello RC. Vocal fold paralysis: improved adductor recovery by vincristine blockade of posterior cricoarytenoid. Laryngoscope 2014; 125:655-60. [PMID: 25267697 DOI: 10.1002/lary.24951] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 08/19/2014] [Accepted: 09/08/2014] [Indexed: 01/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS A new treatment for acute unilateral vocal-fold paralysis (UVFP) was proposed in which a drug is injected into the posterior cricoarytenoid muscle (PCA) shortly after nerve injury, before the degree of natural recovery is known, to prevent antagonistic synkinetic reinnervation. This concept was tested in a series of canine experiments using vincristine as the blocking agent. STUDY DESIGN Animal experiments. METHODS Laryngeal adductor function was measured at baseline and at 6 months following experimental recurrent laryngeal nerve (RLN) injuries, including complete transection, crush injury, and cautery. In the treatment animals, the PCA was injected with vincristine at the time of RLN injury. RESULTS Adductor function in the vincristine-treated hemilarynges was significantly improved compared with injury-matched noninjected controls (total n = 43). Transection/repair controls recovered 56.1% of original adductor strength; vincristine-treated hemilarynges recovered to 73.1% (P = 0.002). Cautery injuries also improved with vincristine block (60.7% vs. 88.7%; P = 0.031). Crush injuries recovered well even without vincristine (104.8% vs. 111.2%; P = 0.35). CONCLUSION These findings support a new paradigm of early, preemptive blockade of the antagonist muscle (PCA) to improve ultimate net adductor strength, which could potentially improve functional recovery in many UVFP patients and avoid the need for medialization procedures. Possible clinical aspects of this new approach are discussed.
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Affiliation(s)
- Randal C Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington University; and the St. Louis VA Medical Center, St. Louis, Missouri, U.S.A
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Sridharan SS, Rosen CA, Smith LJ, Young VN, Munin MC. Timing of nimodipine therapy for the treatment of vocal fold paralysis. Laryngoscope 2014; 125:186-90. [DOI: 10.1002/lary.24903] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 07/16/2014] [Accepted: 08/04/2014] [Indexed: 11/09/2022]
Affiliation(s)
| | - Clark A. Rosen
- Department of Otolaryngology; University of Pittsburgh Voice Center
| | - Libby J. Smith
- Department of Otolaryngology; University of Pittsburgh Voice Center
| | - VyVy N. Young
- Department of Otolaryngology; University of Pittsburgh Voice Center
| | - Michael C. Munin
- Department of Physical Medicine and Rehabilitation; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania U.S.A
- Department of Otolaryngology; University of Pittsburgh School of Medicine; Pittsburgh Pennsylvania U.S.A
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Choi JS, Oh SH, An HY, Kim YM, Lee JH, Lim JY. Functional regeneration of recurrent laryngeal nerve injury during thyroid surgery using an asymmetrically porous nerve guide conduit in an animal model. Thyroid 2014; 24:52-9. [PMID: 24015805 PMCID: PMC3887462 DOI: 10.1089/thy.2013.0338] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Vocal cord paralysis (VCP) caused by recurrent laryngeal nerve (RLN) damage during thyroidectomy commonly results in serious medico-legal problems. The purpose of this study was to evaluate the usefulness of an asymmetrically porous polycaprolactone (PCL)/Pluronic F127 nerve guide conduit (NGC) for functional regeneration in a RLN injury animal model. METHODS A biodegradable, asymmetrically porous PCL/F127 NGC with selective permeability was fabricated for use in this study. A 10-mm segment of left RLN was resected in 28 New Zealand white rabbits, and then an asymmetrically porous NGC or a nonporous silicone tube was interposed between both stumps and securely fixed. Vocal cord mobility was endoscopically evaluated at one, four, and eight weeks postoperatively. Nerve growth through NGCs was assessed by toluidine blue staining, and thyroarytenoid (TA) muscle atrophy was evaluated by hematoxylin and eosin staining. Immunohistochemical stainings for acetylcholinesterase (AchE), anti-neurofilament (NF), and anti-S100 protein were also conducted, and transmission electron microscopy (TEM) was used to evaluate functional nerve regeneration. RESULTS At eight weeks postoperatively, endoscopic evaluations showed significantly better recovery from VCP in the asymmetrically porous PCL/F127 NGC group (6 of 10 rabbits) than in the silicone tube group (1 of 10 rabbits). Continued nerve growth on the damaged nerve endings was observed with time in the asymmetrically porous PCL/F127 NGC-interposed RLNs. TA muscle dimensions and AchE expressions in TA muscle were significantly greater in the asymmetrically porous PCL/F127 NGC group than in the silicone tube group. Furthermore, immunohistochemical staining revealed the expression of NF and S100 protein in the regenerated nerves in the asymmetrically porous PCL/F127 NGC group at eight weeks postoperatively, and at this time, TEM imaging showed myelinated axons in the regenerated RLNs. CONCLUSION The study shows that asymmetrically porous PCL/F127 NGC provides a favorable environment for RLN regeneration and that it has therapeutic potential for the regeneration of RLN damage.
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Affiliation(s)
- Jeong-Seok Choi
- Department of Otorhinolaryngology–Head and Neck Surgery, Inha University School of Medicine, Incheon, Republic of Korea
- Translational Research Center, Inha University School of Medicine, Incheon, Republic of Korea
| | - Se Heang Oh
- Department of Nanobiomedical Science & WCU Research Center, Dankook University, Cheonan, Republic of Korea
| | - Hye-Young An
- Department of Otorhinolaryngology–Head and Neck Surgery, Inha University School of Medicine, Incheon, Republic of Korea
- Translational Research Center, Inha University School of Medicine, Incheon, Republic of Korea
| | - Young-Mo Kim
- Department of Otorhinolaryngology–Head and Neck Surgery, Inha University School of Medicine, Incheon, Republic of Korea
- Translational Research Center, Inha University School of Medicine, Incheon, Republic of Korea
| | - Jin Ho Lee
- Department of Advanced Materials, Hannam University, Daejeon, Republic of Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology–Head and Neck Surgery, Inha University School of Medicine, Incheon, Republic of Korea
- Translational Research Center, Inha University School of Medicine, Incheon, Republic of Korea
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12
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Current world literature. Curr Opin Pediatr 2012; 24:770-9. [PMID: 23146873 DOI: 10.1097/mop.0b013e32835af8de] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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