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Marques JA, Marronnier A, Crampon F, Lagier A, Marie JP. Early Management of Acute Unilateral Vocal Fold Paralysis: Update of the Literature. J Voice 2020; 35:924-926. [DOI: 10.1016/j.jvoice.2020.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
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Mattsson P, Frostell A, Björck G, Persson JKE, Hakim R, Zedenius J, Svensson M. Recovery of Voice After Reconstruction of the Recurrent Laryngeal Nerve and Adjuvant Nimodipine. World J Surg 2018; 42:632-638. [PMID: 29282507 PMCID: PMC5801379 DOI: 10.1007/s00268-017-4235-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Transection injury to the recurrent laryngeal nerve (RLN) has been associated with permanent vocal fold palsy, and treatment has been limited to voice therapy or local treatment of vocal folds. Microsurgical repair has been reported to induce a better function. The calcium channel antagonist nimodipine improves functional recovery after experimental nerve injury and also after cranial nerve injury in patients. This study aims to present voice outcome in patients who underwent repair of the RLN and received nimodipine during regeneration. Methods From 2002–2016, 19 patients were admitted to our center with complete unilateral injury to the RLN and underwent microsurgical repair of the RLN. After nerve repair, patients received nimodipine for 2–3 months. Laryngoscopy was performed repeatedly up to 14 months postoperatively. The Voice Handicap Index (VHI) was administered, and patients’ maximum phonation time (MPT) was recorded during the follow-up. Results All patients recovered well after surgery, and nimodipine was well tolerated with no dropouts. None of the patients suffered from atrophy of the vocal fold, and some patients even showed a small ab/adduction of the vocal fold on the repaired side with laryngoscopy. During long-term follow-up (>3 years), VHI and MPT normalized, indicating a nearly complete recovery from unilateral RLN injury. Conclusions In this cohort study, we report the results of the first 19 consecutive cases at our center subjected to reconstruction of the RLN and adjuvant nimodipine treatment. The outcome of the current strategy is encouraging and should be considered after iatrogenic RLN transection injuries.
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Affiliation(s)
- P Mattsson
- Division of Clinical CNS Research, Section of Neurosurgery, Department of Clinical Neuroscience, Karolinska Institutet R2:02, Karolinska University Hospital, 171 76, Stockholm, Sweden. .,Department of Breast, Endocrine and Sarcoma Tumors, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - A Frostell
- Division of Clinical CNS Research, Section of Neurosurgery, Department of Clinical Neuroscience, Karolinska Institutet R2:02, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - G Björck
- Department of ENT Surgery, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - J K E Persson
- Division of Clinical CNS Research, Section of Neurosurgery, Department of Clinical Neuroscience, Karolinska Institutet R2:02, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - R Hakim
- Division of Clinical CNS Research, Section of Neurosurgery, Department of Clinical Neuroscience, Karolinska Institutet R2:02, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - J Zedenius
- Department of Breast, Endocrine and Sarcoma Tumors, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - M Svensson
- Division of Clinical CNS Research, Section of Neurosurgery, Department of Clinical Neuroscience, Karolinska Institutet R2:02, Karolinska University Hospital, 171 76, Stockholm, Sweden.,Department of Neurosurgery, Karolinska University Hospital, 171 76, Stockholm, Sweden
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Rosen CA, Smith L, Young V, Krishna P, Muldoon MF, Munin MC. Prospective investigation of nimodipine for acute vocal fold paralysis. Muscle Nerve 2014; 50:114-8. [PMID: 24639294 DOI: 10.1002/mus.24111] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 10/21/2013] [Accepted: 10/28/2013] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Nimodipine has been shown to be beneficial for recovery from acute vocal fold paralysis (AVFP) in an animal model. METHODS prospective, open-label trial of patients with AVFP was performed using nimodipine. Consecutive patients were evaluated and offered nimodipine therapy. RESULTS Fifty-three patients were considered for treatment with nimodipine. Thirteen did not qualify for inclusion, 5 were lost to follow-up, and 7 had side effects requiring cessation of treatment. Thus 28 patients (30 paralyzed vocal folds) were analyzed. Eighteen of the paralyzed vocal folds experienced recovery of purposeful motion (60%). Historical controls and laryngeal electromyography meta-analysis suggest no more than a 20% recovery rate from AVFP. CONCLUSIONS This open label study using nimodipine for treatment of AVFP demonstrates tripling of the recovery rate of vocal fold motion compared with historical controls. Further study in a randomized, controlled manner is warranted.
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Affiliation(s)
- Clark A Rosen
- University of Pittsburgh Voice Center, Department of Otolaryngology, University of Pittsburgh School of Medicine, UPMC Mercy Building B, Suite 11500, 1400 Locust Street, Pittsburgh, Pennsylvania, 15219, USA
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Nishimoto K, Kumai Y, Sanuki T, Minoda R, Yumoto E. The impact of nimodipine administration combined with nerve-muscle pedicle implantation on long-term denervated rat thyroarytenoid muscle. Laryngoscope 2012; 123:952-9. [PMID: 22965496 DOI: 10.1002/lary.23698] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the impact of nimodipineon reinnervation of the long-term denervated rat thyroarytenoid (TA) muscle following nerve-muscle pedicle flap (NMP) implantation. STUDY DESIGN Quantitative histologic and physiologic assessments. METHODS Using 120 Wistar rats, we performed NMP implantation at different times after transection of the left recurrent laryngeal nerve (RLN). Sixty animals received nimodipine treatment (NIMO [+] group), and the remaining 60 animals received no nimodipine treatment (NIMO [-] group). As a control, an additional 28 animals were subjected only to transection of the left RLN (DNV group). Subgroups were assigned based on the period after RLN transection (0 [immediate], 8, 16, and 32 weeks). In the DNV group, we assessed histologically the muscle area, axons, neuromuscular junctions (NMJs), and myosin heavy chains (MyHC) type IIA and IIB in the TA muscle. In the NIMO (-) and NIMO (+) groups, histologic assessments and evoked electromyography were performed on the TA muscle at 10 weeks post-NMP implantation. RESULTS In 8-week interval subgroups, the muscle fiber area and the number of NMJs in the NIMO (+) group were significantly greater than in the NIMO (-) group (P < 0.05, each). In the 0-week and 32-week interval subgroups, the muscle fiber subtype changed significantly, from IIA to IIB (P < 0.01 and P < 0.05, respectively); and, at all time-points the muscle fiber area, number of NMJs, and action potentials in the TA muscle tended to be greater in the NIMO (+) group than in the NIMO (-) group. CONCLUSIONS Nimodipine expedited the effects of NMP implantation on reinnervation of the long-term denervated TA muscle. Laryngoscope, 2012.
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Affiliation(s)
- Kohei Nishimoto
- Department of Otolaryngology Head and Neck Surgery, Kumamoto University, Graduate School of Medicine, Kumamoto, Japan.
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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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