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Abstract
BACKGROUND Vocal cord palsy is one of the recognised complications of complex cardiac surgery in the paediatric population. While there is an abundance of literature highlighting the presence of this complication, there is a scarcity of research focusing on the pathophysiology, presentation, diagnosis, and treatment options available for children affected by vocal cord palsy. MATERIALS AND METHODS Electronic searches were conducted using the search terms: "Vocal Cord Palsy," "VCP," "Vocal Cord Injury," "Paediatric Heart Surgery," "Congenital Heart Surgery," "Pediatric Heart Surgery," "Vocal Fold Movement Impairment," "VFMI," "Vocal Fold Palsy," "PDA Ligation." The inclusion criteria were any articles discussing the outcomes of vocal cord palsy following paediatric cardiac surgery. RESULTS The two main populations affected by vocal cord palsy are children undergoing aortic arch surgery or those undergoing PDA ligation. There is paucity of prospective follow-up studies; it is therefore difficult to reliably assess the current approaches and the long-term implications of management options. CONCLUSION Vocal cord palsy can be a devastating complication following cardiac surgery, which if left untreated, could potentially result in debilitation of quality of life and in severe circumstances could even lead to death. Currently, there is not enough high-quality evidence in the literature to aid recognition, diagnosis, and management leaving clinicians to extrapolate evidence from adult studies to make clinical judgements. Future research with a focus on the paediatric perspective is necessary in providing evidence for good standards of care.
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Suzuki H, Araki K, Matsui T, Tanaka Y, Uno K, Tomifuji M, Yamashita T, Satoh Y, Kobayashi Y, Shiotani A. TrkA inhibitor promotes motor functional regeneration of recurrent laryngeal nerve by suppression of sensory nerve regeneration. Sci Rep 2020; 10:16892. [PMID: 33037246 PMCID: PMC7547101 DOI: 10.1038/s41598-020-72288-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/19/2020] [Indexed: 11/19/2022] Open
Abstract
Recurrent laryngeal nerve (RLN) injury, in which hoarseness and dysphagia arise as a result of impaired vocal fold movement, is a serious complication. Misdirected regeneration is an issue for functional regeneration. In this study, we demonstrated the effect of TrkA inhibitors, which blocks the NGF-TrkA pathway that acts on the sensory/automatic nerves thus preventing misdirected regeneration among motor and sensory nerves, and thereby promoting the regeneration of motor neurons to achieve functional recovery. RLN axotomy rat models were used in this study, in which cut ends of the nerve were bridged with polyglycolic acid-collagen tube with and without TrkA inhibitor (TrkAi) infiltration. Our study revealed significant improvement in motor nerve fiber regeneration and function, in assessment of vocal fold movement, myelinated nerve regeneration, compound muscle action potential, and prevention of laryngeal muscle atrophy. Retrograde labeling demonstrated fewer labeled neurons in the vagus ganglion, which confirmed reduced misdirected regeneration among motor and sensory fibers, and a change in distribution of the labeled neurons in the nucleus ambiguus. Our study demonstrated that TrkAi have a strong potential for clinical application in the treatment of RLN injury.
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Affiliation(s)
- Hiroshi Suzuki
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.,Department of Otolaryngology, Self-Defense Forces Central Hospital, Tokyo, Japan
| | - Koji Araki
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - Toshiyasu Matsui
- Department of Anatomy and Neurobiology, National Defense Medical College, Tokorozawa, Japan.,Laboratory of Veterinary Anatomy, Faculty of Veterinary Medicine, Okayama University of Science, Imabari, Japan
| | - Yuya Tanaka
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Kosuke Uno
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Masayuki Tomifuji
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Taku Yamashita
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.,Department of Otolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yasushi Satoh
- Department of Biochemistry, National Defense Medical College, Tokorozawa, Japan
| | - Yasushi Kobayashi
- Department of Anatomy and Neurobiology, National Defense Medical College, Tokorozawa, Japan
| | - Akihiro Shiotani
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
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3
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Asai R, Ishii S, Mikoshiba I, Kazama T, Matsuzaki H, Oshima T, Matsumoto T. Functional recurrent laryngeal nerve regeneration using a silicon tube containing a collagen gel in a rat model. PLoS One 2020; 15:e0237231. [PMID: 32853250 PMCID: PMC7451556 DOI: 10.1371/journal.pone.0237231] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022] Open
Abstract
In this study, we examined the effect of differing gap lengths on regeneration of transected recurrent laryngeal nerves using silicon tubes containing type I collagen gel and the ability of this regeneration to result in restoration of vocal fold movements in rats. We simulated nerve gaps in Sprague-Dawley rats by transecting the left recurrent laryngeal nerves and bridged the nerve stumps using silicon tubes containing type 1 collagen gel. Three experimental groups, in which the gap lengths between the stumps were 1, 3, or 5 mm, were compared with a control group in which the nerve was transected but was not bridged. After surgery, we observed vocal fold movements over time with a laryngoscope. At week 15, we assessed the extent of nerve regeneration in the tube, histologically and electrophysiologically. We also assessed the degree of atrophy of the thyroarytenoid muscle (T/U ratio). Restoration of vocal fold movements was observed in 9 rats in the 1-mm group, in 6 rats in the 3-mm group, and in 3 rats in the 5-mm group. However, in most rats, restoration was temporary, with only one rat demonstrating continued vocal fold movements at week 15. In electromyograph, evoked potentials were observed in rats in the 1-mm and 3-mm groups. Regenerated tissue in the tube was thickest in the 1-mm group, followed by the 3-mm and 5-mm groups. The regenerated tissue showed the presence of myelinated and unmyelinated nerve fibers. In assessment of thyroarytenoid muscle atrophy, the T/U ratio was highest in the 1-mm group, followed by the 3-mm and 5-mm groups. We successfully regenerated the nerves and produced a rat model of recurrent laryngeal nerve regeneration that demonstrated temporary recovery of vocal fold movements. This rat model could be useful for assessing novel treatments developing in the future.
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Affiliation(s)
- Ryohei Asai
- Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
- * E-mail:
| | - Sohei Ishii
- Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Ikuo Mikoshiba
- Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tomohiko Kazama
- Department of Functional Morphology, Division of Cell Regeneration and Transplantation, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroumi Matsuzaki
- Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Takeshi Oshima
- Department of Otolaryngology-Head and Neck Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Taro Matsumoto
- Department of Functional Morphology, Division of Cell Regeneration and Transplantation, Nihon University School of Medicine, Tokyo, Japan
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4
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Trozzi M, Meucci D, Salvati A, Tropiano ML, Bottero S. Surgical Options for Pediatric Bilateral Vocal Cord Palsy: State of the Art. Front Pediatr 2020; 8:538562. [PMID: 33363058 PMCID: PMC7755890 DOI: 10.3389/fped.2020.538562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/09/2020] [Indexed: 01/17/2023] Open
Abstract
Management of pediatric bilateral vocal cord palsy (BVCP) is a controversial and challenging topic. It may represent a severe obstructive condition usually associated with respiratory distress, and, in such condition, tracheostomy has been considered the gold standard for a long time. Many surgical options have been described and used to increase the glottic space in BVCP (1), with ongoing research of less invasive techniques. The challenge and current trend in our department and in many major pediatric centers is to avoid tracheotomy through an early treatment. Many techniques introduced in the last decade reduced the number of tracheotomies and increased the decannulation rate. Furthermore, we observed a recent increase in attention to preserve the quality of the voice with new techniques, such as endoscopic arytenoid abduction lateropexy which is in our opinion an important innovation to improve glottic space with satisfactory voice results. We present a review of the literature about the evolution of the treatment options for pediatric BVCP during the years.
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Affiliation(s)
- Marilena Trozzi
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Duino Meucci
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Antonio Salvati
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Maria Luisa Tropiano
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Sergio Bottero
- Airway Surgery Unit, Pediatric Surgery Department, Bambino Gesù Children's Hospital, Rome, Italy
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5
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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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6
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Li Y, Garrett G, Zealear D. Current Treatment Options for Bilateral Vocal Fold Paralysis: A State-of-the-Art Review. Clin Exp Otorhinolaryngol 2017; 10:203-212. [PMID: 28669149 PMCID: PMC5545703 DOI: 10.21053/ceo.2017.00199] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 06/02/2017] [Accepted: 06/19/2017] [Indexed: 12/31/2022] Open
Abstract
Vocal fold paralysis (VFP) refers to neurological causes of reduced or absent movement of one or both vocal folds. Bilateral VFP (BVFP) is characterized by inspiratory dyspnea due to narrowing of the airway at the glottic level with both vocal folds assuming a paramedian position. The primary objective of intervention for BVFP is to relieve patients’ dyspnea. Common clinical options for management include tracheostomy, arytenoidectomy and cordotomy. Other options that have been used with varying success include reinnervation techniques and botulinum toxin (Botox) injections into the vocal fold adductors. More recently, research has focused on neuromodulation, laryngeal pacing, gene therapy, and stem cell therapy. These newer approaches have the potential advantage of avoiding damage to the voicing mechanism of the larynx with an added goal of restoring some physiologic movement of the affected vocal folds. However, clinical data are scarce for these new treatment options (i.e., reinnervation and pacing), so more investigative work is needed. These areas of research are expected to provide dramatic improvements in the treatment of BVFP.
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Affiliation(s)
- Yike Li
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gaelyn Garrett
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David Zealear
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
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7
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Wang B, Yuan J, Xu J, Chen X, Ying X, Dong P. Brain-derived and glial cell line-derived neurotrophic factor fusion protein immobilization to laminin. Exp Ther Med 2016; 13:178-186. [PMID: 28123487 PMCID: PMC5245157 DOI: 10.3892/etm.2016.3925] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/01/2016] [Indexed: 11/06/2022] Open
Abstract
Damage to the recurrent laryngeal nerve often causes hoarseness, dyspnea, dysphagia, and sometimes asphyxia due to vocal cord paralysis which result in a reduction of quality of life. Brain-derived neurotrophic factor (BDNF) and glial cell line-derived neurotrophic factor (GDNF) play critical roles in peripheral nerve regeneration. However, methods for efficiently delivering these molecules are lacking, which limits their use in clinical applications. The present study reports an effective strategy for targeting BDNF and GDNF to laminin by fusing the N-terminal domains of these molecules with agrin (NtA). More specifically, laminin-binding efficacy was assessed and sustained release assays of the delivery of BDNF or GDNF fused with NtA (LBD-BDNF or LBD-GDNF) to laminin were conducted in vitro. In addition, the bioactivity of LBD-BDNF and LBD-GDNF on laminin in vitro was investigated. LBD-BDNF and LBD-GDNF were each able to specifically bind to laminin and maintain their activity in vitro. Moreover, neurotrophic factors with NtA retained higher concentrations and bioactivity levels compared with those without NtA. The ratio of LBD-BDNF and LBD-GDNF that produced optimal effects was 4:6. BDNF and GDNF fused with NtA were effective in specifically binding to laminin. As laminin is a major component of the extracellular matrix, LBD-BDNF and LBD-GDNF may prove useful in the repair of peripheral nerve injuries.
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Affiliation(s)
- Baoxin Wang
- Department of Otolaryngology, Head and Neck Surgery, Shanghai Jiao Tong University Affiliated to Shanghai First People's Hospital, Shanghai 201620, P.R. China
| | - Junjie Yuan
- Department of Orthopedics, Shanghai Fengxian District Central Hospital, Shanghai Jiao Tong University Affiliated to Sixth People's Hospital South Campus, Shanghai 200011, P.R. China
| | - Jiafeng Xu
- School of Economics and Finance, Shanghai International Studies University, Shanghai 200083, P.R. China
| | - Xinwei Chen
- Department of Otolaryngology, Head and Neck Surgery, Shanghai Jiao Tong University Affiliated to Shanghai First People's Hospital, Shanghai 201620, P.R. China
| | - Xinjiang Ying
- Department of Otolaryngology, Head and Neck Surgery, Shanghai Jiao Tong University Affiliated to Shanghai First People's Hospital, Shanghai 201620, P.R. China
| | - Pin Dong
- Department of Otolaryngology, Head and Neck Surgery, Shanghai Jiao Tong University Affiliated to Shanghai First People's Hospital, Shanghai 201620, P.R. China
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8
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Monaco GN, Brown TJ, Burgette RC, Fargo KN, Akst LM, Jones KJ, Foecking EM. Electrical stimulation and testosterone enhance recovery from recurrent laryngeal nerve crush. Restor Neurol Neurosci 2016; 33:571-8. [PMID: 23902984 DOI: 10.3233/rnn-130334] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE This study investigated the effects of a combinatorial treatment, consisting of a brief period of nerve electrical stimulation (ES) and systemic supraphysiologic testosterone, on functional recovery following a crush of the recurrent laryngeal nerve (RLN). STUDY DESIGN Prospective, controlled animal study. METHODS After a crush of the left RLN, adult male Sprague-Dawley rats were divided into four treatment groups: 1) no treatment, 2) ES, 3) testosterone propionate (TP), and 4) ES + TP. Each group was subdivided into 1, 2, 3, or 4 weeks post-operative survival time points. Groups had an n of 4- 9. Recovery of vocal fold mobility (VFM) was assessed. RESULTS Brief ES of the proximal nerve alone or in combination with TP accelerated the initiation of functional recovery. TP administration by itself also produced increased VFM scores compared to controls, but there were no statistical differences between the ES-treated and TP-treated animals. Treatment with brief ES alone was sufficient to decrease the time required to recover complete VFM. Animals with complete VFM were seen in treatment groups as early as 1 week following injury; in the untreated group, this was not observed until at least 3 weeks post-injury, translating into a 66% decrease in time to complete recovery. CONCLUSIONS Brief ES, alone or in combination with TP, promise to be effective therapeutic interventions for promoting regeneration following RLN injury.
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Affiliation(s)
- Gina N Monaco
- Cell Biology, Neurobiology, and Anatomy Program, Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Todd J Brown
- R&D Services, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.,Department of Anatomy & Cell Biology, Indiana School of Medicine, Indianapolis, IN, USA
| | - Ryan C Burgette
- Department of Otolaryngology - Head & Neck Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Keith N Fargo
- R&D Services, Edward Hines, Jr. VA Hospital, Hines, IL, USA
| | - Lee M Akst
- Department of Otolaryngology - Head & Neck Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Kathryn J Jones
- R&D Services, Richard L. Roudebush VA Medical Center, Indianapolis, IN, USA.,Department of Anatomy & Cell Biology, Indiana School of Medicine, Indianapolis, IN, USA
| | - Eileen M Foecking
- R&D Services, Edward Hines, Jr. VA Hospital, Hines, IL, USA.,Department of Otolaryngology - Head & Neck Surgery, Loyola University Medical Center, Maywood, IL, USA
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Wang B, Yuan J, Xu J, Xie J, Wang G, Dong P. Neurotrophin expression and laryngeal muscle pathophysiology following recurrent laryngeal nerve transection. Mol Med Rep 2015; 13:1234-42. [PMID: 26677138 PMCID: PMC4732864 DOI: 10.3892/mmr.2015.4684] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 11/19/2015] [Indexed: 11/05/2022] Open
Abstract
Laryngeal palsy often occurs as a result of recurrent laryngeal or vagal nerve injury during oncological surgery of the head and neck, affecting quality of life and increasing economic burden. Reinnervation following recurrent laryngeal nerve (RLN) injury is difficult despite development of techniques, such as neural anastomosis, nerve grafting and creation of a laryngeal muscle pedicle. In the present study, due to the limited availability of human nerve tissue for research, a rat model was used to investigate neurotrophin expression and laryngeal muscle pathophysiology in RLN injury. Twenty-five male Sprague-Dawley rats underwent right RLN transection with the excision of a 5-mm segment. Vocal fold movements, vocalization, histology and immunostaining were evaluated at different time-points (3, 6, 10 and 16 weeks). Although vocalization was restored, movement of the vocal fold failed to return to normal levels following RLN injury. The expression of brain‑derived neurotrophic factor and glial cell line-derived neurotrophic factor differed in the thyroarytenoid (TA) and posterior cricoarytenoid muscles. The number of axons did not increase to baseline levels over time. Furthermore, normal muscle function was unlikely with spontaneous reinnervation. During regeneration following RLN injury, differences in the expression levels of neurotrophic factors may have resulted in preferential reinnervation of the TA muscles. Data from the present study indicated that neurotrophic factors may be applied for restoring the function of the laryngeal nerve following recurrent injury.
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Affiliation(s)
- Baoxin Wang
- Department of Otolaryngology, Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, P.R. China
| | - Junjie Yuan
- Department of Orthopedics, Shanghai Fengxian District Central Hospital, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai 200011, P.R. China
| | - Jiafeng Xu
- School of Economics and Finance, Shanghai International Studies University, Shanghai 200083, P.R. China
| | - Jin Xie
- Department of Otolaryngology, Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, P.R. China
| | - Guoliang Wang
- Department of Otolaryngology, Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, P.R. China
| | - Pin Dong
- Department of Otolaryngology, Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201620, P.R. China
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10
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Suzuki H, Araki K, Matsui T, Tomifuji M, Yamashita T, Kobayashi Y, Shiotani A. Value of a novel PGA-collagen tube on recurrent laryngeal nerve regeneration in a rat model. Laryngoscope 2015; 126:E233-9. [PMID: 26525485 DOI: 10.1002/lary.25750] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 08/13/2015] [Accepted: 09/15/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Nerbridge (Toyobo Co., Ltd., Osaka, Japan) is a novel polyglycolic acid (PGA) tube that is filled with collagen fibers and that facilitates nerve fiber expansion and blood vessel growth. It is biocompatible and commercially available, with governmental approval for practical use in Japan. We hypothesized that the PGA-collagen tube would promote regeneration of the recurrent laryngeal nerve (RLN). This hypothesis was examined in a rat axotomy model of the RLN. STUDY DESIGN Prospective animal study. METHODS The axotomy model was established by transection of the left RLN in adult Sprague-Dawley rats. The cut ends of the nerve were bridged using Nerbridge (Toyobo Co., Ltd.) with a 1-mm gap (tube-treatment group) or direct sutures (sutured-control group). Left vocal fold mobility, nerve conduction velocity, morphology, and histology were assessed after 15 weeks. RESULTS Fifteen weeks after treatment, nerve fiber connections were observed macroscopically in both groups, and more clear myelinated fibers and better prevention of laryngeal muscle atrophy were observed in the tube-treatment group compared with the sutured-control group. However, vocal fold movement recovery was not observed in either group, and the conduction velocity of the RLN did not differ between the two groups. CONCLUSIONS Better nerve regeneration was observed in the tube-treatment group. The combination therapy with molecular or gene therapy might be an effective strategy to improve vocal fold movement. The PGA-collagen tube has the potential to promote regeneration of the RLN and to be a scaffold for drug administration in these combination therapies. LEVEL OF EVIDENCE N/A. Laryngoscope, 126:E233-E239, 2016.
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Affiliation(s)
- Hiroshi Suzuki
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Koji Araki
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Toshiyasu Matsui
- Department of Anatomy and Neurobiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masayuki Tomifuji
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Taku Yamashita
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yasushi Kobayashi
- Department of Anatomy and Neurobiology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Akihiro Shiotani
- Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
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11
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Zhao W, Xu W, Yang WW. Neuroregeneration in the nucleus ambiguus after recurrent laryngeal nerve avulsion in rats. Ann Otol Rhinol Laryngol 2014; 123:490-9. [PMID: 24627406 DOI: 10.1177/0003489414524170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The objective was to investigate neuroregeneration, the origins of newborn cells and the proliferation of neuronal and glial cells in the nucleus ambiguus (NA) after ipsilateral recurrent laryngeal nerve (RLN) avulsion. METHODS All of the animals received a CM-Dil injection in the left lateral ventricle. Forty-five adult rats were subjected to a left RLN avulsion injury, while 9 rats were used as controls. 5-Bromo-2-deoxyuridine (BrdU) was injected intraperitoneally. Neuron quantification and immunohistochemical analysis were performed in the brain stems at different time points after RLN injury. RESULTS After RLN avulsion, CM-Dil labeled neural progenitor cells (NPCs) migrated to the ipsilateral NA and differentiated into astrocytes but not into neurons. In the NA, the neuronal cells re-expressed nestin. Only a small number of neuronal and glial cells in the NA showed BrdU immunoreactivity. CONCLUSIONS After RLN avulsion, the NPCs in the ependymal layer of the fourth ventricle or central canal are activated, migrate to the lesion in the NA and differentiate exclusively into astrocytes. The newborn neural stem cells in the NA may arise from the mature region neurons. The presence of both cell types in the NA may play a role in repairing RLN injuries.
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12
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Pitman MJ, Berzofsky CE, Alli O, Sharma S. Embryologic innervation of the rat laryngeal musculature-a model for investigation of recurrent laryngeal nerve reinnervation. Laryngoscope 2013; 123:3117-26. [DOI: 10.1002/lary.24216] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 04/19/2013] [Accepted: 04/19/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Michael J. Pitman
- New York Eye and Ear Infirmary, Department of Otolaryngology; Voice and Swallowing Institute; New York New York
| | - Craig E. Berzofsky
- Division of Laryngology; New York Eye and Ear Infirmary, Department of Otolaryngology; New York New York
| | - Opeyemi Alli
- New York Medical College, School of Medicine; Valhalla New York New York U.S.A
| | - Sansar Sharma
- Department of Cell Biology; New York Medical College; Valhalla New York
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13
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Mizokami D, Araki K, Tanaka N, Suzuki H, Tomifuji M, Yamashita T, Inoue M, Hasegawa M, Shiotani A. Sendai virus transgene in a novel gene therapy for laryngotracheal disease. Laryngoscope 2013; 123:1717-24. [DOI: 10.1002/lary.23917] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2012] [Indexed: 12/14/2022]
Affiliation(s)
- Daisuke Mizokami
- Department of Otolaryngology-Head & Neck Surgery; National Defense Medical College; Tokorozawa; Saitama
| | - Koji Araki
- Department of Otolaryngology-Head & Neck Surgery; National Defense Medical College; Tokorozawa; Saitama
| | - Nobuaki Tanaka
- Department of Otolaryngology-Head & Neck Surgery; National Defense Medical College; Tokorozawa; Saitama
| | - Hiroshi Suzuki
- Department of Otolaryngology-Head & Neck Surgery; National Defense Medical College; Tokorozawa; Saitama
| | - Masayuki Tomifuji
- Department of Otolaryngology-Head & Neck Surgery; National Defense Medical College; Tokorozawa; Saitama
| | - Taku Yamashita
- Department of Otolaryngology-Head & Neck Surgery; National Defense Medical College; Tokorozawa; Saitama
| | | | | | - Akihiro Shiotani
- Department of Otolaryngology-Head & Neck Surgery; National Defense Medical College; Tokorozawa; Saitama
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Nishimoto K, Kumai Y, Minoda R, Yumoto E. Nimodipine accelerates reinnervation of denervated rat thyroarytenoid muscle following nerve-muscle pedicle implantation. Laryngoscope 2012; 122:606-13. [DOI: 10.1002/lary.22487] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Accepted: 11/11/2011] [Indexed: 01/24/2023]
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Pitman MJ, Weissbrod P, Roark R, Sharma S, Schaefer SD. Electromyographic and histologic evolution of the recurrent laryngeal nerve from transection and anastomosis to mature reinnervation. Laryngoscope 2011; 121:325-31. [DOI: 10.1002/lary.21290] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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16
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Receptor tyrosine kinases and respiratory motor plasticity. Respir Physiol Neurobiol 2009; 164:242-51. [PMID: 18634908 DOI: 10.1016/j.resp.2008.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2008] [Revised: 06/13/2008] [Accepted: 06/18/2008] [Indexed: 11/23/2022]
Abstract
Protein kinases are a family of enzymes that transfer a phosphate group from adenosine tri-phosphate to an amino acid residue on a protein. The receptor tyrosine kinases (RTKs) are expressed on the outer cell membrane, bind extracellular protein ligands, and phosphorylate tyrosine residues on other proteins-essentially permitting communication between cells. Such activity regulates multiple aspects of cellular physiology including cell growth and differentiation, adhesion, motility, cell death, and morphological and synaptic plasticity. This review will focus on the role of RTKs in respiratory motor plasticity, with particular emphasis on long-term changes in respiratory motoneuron function. Reflecting the predominant literature, specific attention will be devoted to the role of tropomyosin-related kinase type B (TrkB) activation on phrenic motoneuron activity. However, many RTKs share similar patterns of expression and mechanisms of ligand-induced activation and downstream signaling. Thus, a perspective based on TrkB-induced phrenic motor plasticity may provide insight into the potential roles of other RTKs in the neural control of breathing. Finally, understanding how different RTKs affect respiratory motor output in the long-term may provide future avenues for pharmacological development with the goal of increasing respiratory motor output in disorders such as obstructive sleep apnea and after spinal cord injury. This is best illustrated in recent studies where we have used small, highly diffusible molecules to transactivate TrkB receptors near phrenic motoneurons to improve breathing after cervical spinal cord injury.
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Bibliography. Current world literature. Laryngology and bronchoesophagology. Curr Opin Otolaryngol Head Neck Surg 2007; 15:417-24. [PMID: 17986882 DOI: 10.1097/moo.0b013e3282f3532f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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