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Experience with laryngeal reinnervation using nerve-muscle pedicle in pediatric patients. Int J Pediatr Otorhinolaryngol 2020; 138:110254. [PMID: 33137867 DOI: 10.1016/j.ijporl.2020.110254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/04/2020] [Accepted: 07/05/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Vocal fold paralysis (VFP) in adducted position remains a challenge for airway surgeons. Alternatives to tracheostomies such as lateralization, cordectomy, and posterior rib grafting disrupt the laryngeal tissue or framework and carry an increased risk of aspiration. Laryngeal reinnervation using nerve-muscle pedicle (NMP), carries the distinct advantage of preserving the larynx, sparing the recurrent laryngeal nerve, and obtaining an active VF abduction. The aim of this study was to evaluate the success and complications of laryngeal reinnervation using nerve-muscle pedicle (NMP) in pediatric patients presenting with dyspnea related to VFP in adducted position. METHODS In this case series performed at a tertiary care referral center, review of medical records on all pediatric patients with VFP in adduction treated with laryngeal reinnervation using NMP between 1999 and 2017. Data were collected on the preoperative flexible laryngoscopy, suspension micro-laryngoscopy, and laryngeal electromyography as well as post-operative clinical assessment of the voice and airway. All patients underwent surgery consisting of the transfer of an innervated omohyoid muscle pedicle onto the paralyzed posterior cricoarytenoid muscle. The main outcomes measured were the clinical and fiberoptic laryngoscopic airway assessment monthly for the first 6 months, then at 12 months and annually thereafter. Clinical assessment included dyspnea evaluation based on a visual analog scale and voice assessment using the GRBAS scores. Complications from the treatment were also noted. These outcomes were determined before collection of data. RESULTS 16 cases were identified, with a mean age of 4 years. The recurrent laryngeal nerve paralysis was bilateral in 3 cases and unilateral in 13 cases. There were no peri or postoperative complications. After a mean follow-up of 7 years, vocal fold abduction was observed in 10 out of 16 cases and disappearance of paradoxical inspiratory adduction in 3 cases. Persistent dyspnea was noted in 7 cases (44%), and moderate dysphonia was present in 11 cases (69%). Finally, additional procedures were necessary in 2 patients (13%) to achieve the outcomes. CONCLUSIONS Laryngeal reinnervation using NMP may be used in pediatric patients. This procedure, is safe and allows us to spare the recurrent laryngeal nerve while obtaining an active VF abduction in the majority of cases, and an improvement in breathing in most cases. QUALITY OF EVIDENCE 4.
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Billante CR, Spector B, Hudson M, Burkard K, Netterville JL. Voice outcome following thyroplasty in patients with cancer-related vocal fold paralysis. Auris Nasus Larynx 2001; 28:315-21. [PMID: 11694375 DOI: 10.1016/s0385-8146(01)00101-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Medialization laryngoplasty restores voice in patients with unilateral laryngeal paralysis. Of question was whether patients with vocal fold paralysis resulting from cancer or its treatment had as good a post-operative voice result as patients with vocal fold paralysis of benign etiology. The purpose of the present study was to compare post-operative perceptual, acoustic, aerodynamic, and quality of life data in these two patient groups. Twenty-eight patients with vocal fold paralysis secondary to malignancy or its treatment were age and gender-matched with patients with paralysis resulting from benign origin. Pre- and post-operative perceptual judgments of pitch, loudness and quality were rated independently by two speech-language pathologists. A digital audiotape of the patient's voice was analyzed using Soundscope software. Fundamental frequency, conversational intensity and perturbation were evaluated. Glottal flow rates in propositional speech, phonation times and extent of pitch and loudness ranges were also measured. Three quality of life surveys, the Short Form-36 general health survey, the Voice Handicap Index, and the Voice Outcomes Study were administered. Results of voice testing indicated that perceptual, acoustic and aerodynamic data were significantly improved 3 months after thyroplasty in all patients regardless of whether they had a history of cancer. Quality of life data, however, distinguished the two groups. In particular, the general health measure found a significant difference in physical functioning and overall vitality, although satisfaction with improved voice was equally appreciated in both patient groups. Of clinical significance is that though general health may differ, patients with cancer-related laryngeal paralysis can expect to have as good a voice outcome following thyroplasty as patients with paralysis of benign etiology.
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Affiliation(s)
- C R Billante
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA.
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Kim ED, Nath R, Kadmon D, Lipshultz LI, Miles BJ, Slawin KM, Tang HY, Wheeler T, Scardino PT. Bilateral nerve graft during radical retropubic prostatectomy: 1-year followup. J Urol 2001; 165:1950-6. [PMID: 11371887 DOI: 10.1097/00005392-200106000-00024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE With the interposition of a sural nerve graft to replace resected cavernous nerves at radical retropubic prostatectomy, we have previously reported the return of effective erectile function. We determine the efficacy of this procedure in a series of men with at least 1-year followup. MATERIALS AND METHODS A total of 12 potent men (mean age plus or minus standard deviation 57 +/- 6 years) with clinically localized prostate cancer underwent radical retropubic prostatectomy, with deliberate wide bilateral neurovascular bundle resection and placement of bilateral nerve grafts. A series of patient and partner erectile dysfunction questionnaires, and patient interviews were performed at 3, 6, 12 and 18 months postoperatively. Only results for those men with a followup of 12 months or greater (mean 16 +/- 4) are presented. A control group of 12 men who had undergone bilateral nerve resection but declined nerve graft placement, was also followed. RESULTS Of the 12 men 4 (33%) had spontaneous medically unassisted erections sufficient for sexual intercourse with vaginal penetration. An additional 5 (42%) men describe "40 to 60%" spontaneous erections, with fullness, no rigidity and not able to penetrate. Overall, 9 (75%) men had return of erectile activity. No demonstrable erections occurred before 5 months postoperatively. The greatest return of function was observed at 14 to 18 months after surgery. CONCLUSIONS This surgical technique has minimal morbidity and represents a significant advance in prostate cancer surgery in men requiring bilateral nerve resection. Our study clearly demonstrates recovery of erectile function in men who underwent bilateral nerve graft placement during radical retropubic prostatectomy when both cavernous nerves were deliberately resected.
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Affiliation(s)
- E D Kim
- Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA
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KIM EDWARDD, NATH RAHUL, KADMON DOV, LIPSHULTZ LARRYI, MILES BRIANJ, SLAWIN KEVINM, TANG HSIAOYUAN, WHEELER THOMAS, SCARDINO PETERT. BILATERAL NERVE GRAFT DURING RADICAL RETROPUBIC PROSTATECTOMY: 1-YEAR FOLLOWUP. J Urol 2001. [DOI: 10.1016/s0022-5347(05)66248-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- EDWARD D. KIM
- From the Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology and Departments of Pathology, Surgery, Neurosurgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, and Department of Surgery, Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - RAHUL NATH
- From the Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology and Departments of Pathology, Surgery, Neurosurgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, and Department of Surgery, Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - DOV KADMON
- From the Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology and Departments of Pathology, Surgery, Neurosurgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, and Department of Surgery, Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - LARRY I. LIPSHULTZ
- From the Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology and Departments of Pathology, Surgery, Neurosurgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, and Department of Surgery, Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - BRIAN J. MILES
- From the Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology and Departments of Pathology, Surgery, Neurosurgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, and Department of Surgery, Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - KEVIN M. SLAWIN
- From the Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology and Departments of Pathology, Surgery, Neurosurgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, and Department of Surgery, Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - HSIAO-YUAN TANG
- From the Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology and Departments of Pathology, Surgery, Neurosurgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, and Department of Surgery, Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - THOMAS WHEELER
- From the Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology and Departments of Pathology, Surgery, Neurosurgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, and Department of Surgery, Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
| | - PETER T. SCARDINO
- From the Matsunaga-Conte Prostate Cancer Research Center, Division of Male Reproductive Medicine and Surgery, Scott Department of Urology and Departments of Pathology, Surgery, Neurosurgery, Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas, and Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, and Department of Surgery, Division of Urology, University of Tennessee Medical Center, Knoxville, Tennessee
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