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Miar S, Walters B, Gonzales G, Malka R, Baker A, Guda T, Dion GR. Augmentation and vocal fold biomechanics in a recurrent laryngeal nerve injury model. Laryngoscope Investig Otolaryngol 2022; 7:1057-1064. [PMID: 36000036 PMCID: PMC9392410 DOI: 10.1002/lio2.853] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives/hypothesis Composite vocal fold (VF) biomechanical data are lacking for augmentation after recurrent laryngeal nerve (RLN) injury. We hypothesize resulting atrophy decreases VF stiffness and augmentation restores native VF biomechanics. Methods Sixteen Yorkshire Crossbreed swine underwent left RLN transection and were observed or underwent carboxymethylcellulose (CMC) or calcium hydroxyapatite (CaHa) augmentation at 2 weeks. Biomechanical measurements (structural stiffness, displacement, and maximum load) were measured at 4 or 12 weeks. Thyroarytenoid (TA) muscle cross‐sectional area was quantified and compared with two‐way ANOVA with Tukey's post hoc test. Results After 4 weeks, right greater than left structural stiffness (mean ± SE) was observed (49.6 ± 0.003 vs. 28.4 ± 0.002 mN/mm), left greater than right displacement at 6.3 mN (0.54 ± 0.01 vs. 0.46 ± 0.01 mm, p < .01) was identified, and right greater than left maximum load (72.3 ± 0.005 vs. 40.8 ± 0.003 mN) was recorded. TA muscle atrophy in the injured group without augmentations was significant compared to the noninjured side, and muscle atrophy was seen at overall muscle area and individual muscle bundles. CMC augmentation appears to maintain TA muscle structure in the first 4 weeks with atrophy present at 12 weeks. Conclusions VF biomechanical properties match TA muscle atrophy in this model, and both CMC and CaHa injection demonstrated improved biomechanical properties and slower TA atrophy compared to the uninjured side. Taken together, these data provide a quantifiable biomechanical basis for early injection laryngoplasty to improve dysphonia and potentially improve healing in reversible unilateral vocal fold atrophy. Level of evidence N/A
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Affiliation(s)
- Solaleh Miar
- Department of Biomedical Engineering and Chemical Engineering The University of Texas San Antonio Texas USA
- USAF 59MDW/ST Oak Ridge Institute for Science and Education Oak Ridge Tennessee USA
| | - Benjamin Walters
- Department of Otolaryngology‐Head and Neck Surgery Brooke Army Medical Center JBSA Fort Sam Houston Texas USA
| | - Gabriela Gonzales
- Department of Biomedical Engineering and Chemical Engineering The University of Texas San Antonio Texas USA
- USAF 59MDW/ST Oak Ridge Institute for Science and Education Oak Ridge Tennessee USA
| | - Ronit Malka
- Department of Otolaryngology‐Head and Neck Surgery Brooke Army Medical Center JBSA Fort Sam Houston Texas USA
| | - Amelia Baker
- Department of Anesthesiology Brooke Army Medical Center JBSA Fort Sam Houston Texas USA
| | - Teja Guda
- Department of Biomedical Engineering and Chemical Engineering The University of Texas San Antonio Texas USA
| | - Gregory R. Dion
- Department of Biomedical Engineering and Chemical Engineering The University of Texas San Antonio Texas USA
- Department of Otolaryngology‐Head and Neck Surgery Brooke Army Medical Center JBSA Fort Sam Houston Texas USA
- Dental and Craniofacial Trauma Research Department U.S. Army Institute of Surgical Research Houston Texas USA
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Nagai H, Nishiyama K, Seino Y, Tabata Y, Yamashita T. Effect of Fascia Implantation and Controlled Release of Basic Fibroblast Growth Factor for Muscle Atrophy in Rat Laryngeal Paralysis. Otolaryngol Head Neck Surg 2021; 167:319-326. [PMID: 34665680 DOI: 10.1177/01945998211052895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To improve lateral thyroarytenoid (TA) muscle atrophy after laryngeal paralysis, reconstruction of the vascular network of the atrophied muscle is necessary. We therefore evaluated whether the controlled release of basic fibroblast growth factor (bFGF) with autologous fascia implantation could affect vascular reconstruction in the lateral TA muscle. STUDY DESIGN Animal experiment. SETTING Laboratory. METHODS Unilateral laryngeal paralysis was induced in 20 rats. The rats were implanted with autologous fascia and a gelatin hydrogel sheet with or without 1 µg of bFGF (fascia and bFGF + fascia groups; n = 5 each) and with only a gelatin hydrogel sheet with bFGF (bFGF group: n = 5). Another group remained untreated (n = 5) at 4 months after paralysis. At 3 months since transplantation, intra- and intergroup comparisons of the muscle volumes and total area of blood vessels in the lateral TA muscle were performed. RESULTS When compared with the untreated group, the bFGF + fascia group showed a significant increase in muscle volume (P =.0008) and vascular area (P =.0002) in the lateral TA muscle, whereas the other 2 treated groups demonstrated an insufficient effect. CONCLUSION bFGF + fascia implantation showed histologic improvement in severe laryngeal paralysis. We demonstrated that the decrease in lateral TA muscle mass after paralysis might be countered by the reconstruction of the vascular network. Our findings indicate that hypovascular and denervated areas of the laryngeal muscle can be regenerated by the implantation of growth factors and scaffolds with surgical stress. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Hiromi Nagai
- Department of Otolaryngology, Yamato Municipal Hospital, Kanagawa, Japan
| | | | - Yutomo Seino
- Department of Otolaryngology-Head and Neck Surgery, Kitasato University, Kanagawa, Japan
| | - Yasuhiko Tabata
- Department of Regeneration Science and Engineering Lab of Biomaterials, Kyoto University, Kyoto, Japan
| | - Taku Yamashita
- Department of Otolaryngology-Head and Neck Surgery, Kitasato University, Kanagawa, Japan
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3
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Dhillon VK, Randolph GW, Stack BC, Lindeman B, Bloom G, Sinclair CF, Woodson G, Brooks JA, Childs LF, Esfandiari NH, Evangelista L, Guardiani E, Quintanilla-Dieck L, Naunheim MR, Shindo M, Singer M, Tolley N, Angelos P, Kupfer R, Banuchi V, Liddy W, Tufano RP. Immediate and partial neural dysfunction after thyroid and parathyroid surgery: Need for recognition, laryngeal exam, and early treatment. Head Neck 2020; 42:3779-3794. [PMID: 32954575 DOI: 10.1002/hed.26472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Laryngeal dysfunction after thyroid and parathyroid surgery requires early recognition and a standardized approach for patients that present with voice, swallowing, and breathing issues. The Endocrine Committee of the American Head and Neck Society (AHNS) convened a panel to define the terms "immediate vocal fold paralysis" and "partial neural dysfunction" and to provide clinical consensus statements based on review of the literature, integrated with expert opinion of the group. METHODS A multidisciplinary expert panel constructed the manuscript and recommendations for laryngeal dysfunction after thyroid and parathyroid surgery. A meta-analysis was performed using the literature and published guidelines. Consensus was achieved using polling and a modified Delphi approach. RESULTS Twenty-two panelists achieved consensus on five statements regarding the role of early identification and standardization of evaluation for patients with "immediate vocal fold paralysis" and "partial neural dysfunction" after thyroid and parathyroid surgery. CONCLUSION After endorsement by the AHNS Endocrine Section and Quality of Care Committee, it received final approval from the AHNS Council.
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Affiliation(s)
- Vaninder K Dhillon
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University National Capital Region, Bethesda, Maryland, USA
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Brenessa Lindeman
- Department of General Surgery, Surgical Oncology, University of Alabama, Birmingham, Alabama, USA
| | - Gary Bloom
- ThyCa: Thyroid Cancer Survivors' Association, Inc., Olney, Maryland, USA
| | - Catherine F Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai West Hospital, New York, New York, USA
| | - Gayle Woodson
- Department of Otolaryngology-Head and Neck Surgery, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jennifer A Brooks
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lesley F Childs
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nazanene H Esfandiari
- Department of Internal Medicine, Metabolism, Endocrinology & Diabetes (MEND), University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa Evangelista
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, California, USA
| | - Elizabeth Guardiani
- Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Lourdes Quintanilla-Dieck
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Oregon, Portland, USA
| | - Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Maisie Shindo
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Oregon, Portland, USA
| | - Michael Singer
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Neil Tolley
- Department of Otolaryngology-Head and Neck Surgery, Imperial College NHS Trust, London, UK
| | - Peter Angelos
- Department of Surgery, University of Chicago School of Medicine, Chicago, Illinois, USA
| | - Robbi Kupfer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Victoria Banuchi
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell School of Medicine, New York, New York, USA
| | - Whitney Liddy
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, Illinois, USA
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
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Mok A, Allen J, Haney MM, Deninger I, Ballenger B, Caywood V, Osman KL, Zitsch B, Hopewell BL, Thiessen A, Szewczyk M, Ohlhausen D, Newberry CI, Leary E, Lever TE. A Surgical Mouse Model for Advancing Laryngeal Nerve Regeneration Strategies. Dysphagia 2019; 35:419-437. [PMID: 31388736 DOI: 10.1007/s00455-019-10045-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/06/2019] [Accepted: 07/31/2019] [Indexed: 01/16/2023]
Abstract
Iatrogenic recurrent laryngeal nerve (RLN) injury is a morbid complication of anterior neck surgical procedures. Existing treatments are predominantly symptomatic, ranging from behavioral therapy to a variety of surgical approaches. Though laryngeal reinnervation strategies often provide muscle tone to the paralyzed vocal fold (VF), which may improve outcomes, there is no clinical intervention that reliably restores true physiologic VF movement. Moreover, existing interventions neglect the full cascade of molecular events that affect the entire neuromuscular pathway after RLN injury, including the intrinsic laryngeal muscles, synaptic connections within the central nervous system, and laryngeal nerve anastomoses. Systematic investigations of this pathway are essential to develop better RLN regenerative strategies. Our aim was to develop a translational mouse model for this purpose, which will permit longitudinal investigations of the pathophysiology of iatrogenic RLN injury and potential therapeutic interventions. C57BL/6J mice were divided into four surgical transection groups (unilateral RLN, n = 10; bilateral RLN, n = 2; unilateral SLN, n = 10; bilateral SLN, n = 10) and a sham surgical group (n = 10). Miniaturized transoral laryngoscopy was used to assess VF mobility over time, and swallowing was assessed using serial videofluoroscopy. Histological assays were conducted 3 months post-surgery for anatomical investigation of the larynx and laryngeal nerves. Eight additional mice underwent unilateral RLN crush injury, half of which received intraoperative vagal nerve stimulation (iVNS). These 8 mice underwent weekly transoral laryngoscopy to investigate VF recovery patterns. Unilateral RLN injury resulted in chronic VF immobility but only acute dysphagia. Bilateral RLN injury caused intraoperative asphyxiation and death. VF mobility was unaffected by SLN transection (unilateral or bilateral), and dysphagia (transient) was evident only after bilateral SLN transection. The sham surgery group retained normal VF mobility and swallow function. Mice that underwent RLN crush injury and iVNS treatment demonstrated accelerated and improved VF recovery. We successfully developed a mouse model of iatrogenic RLN injury with impaired VF mobility and swallowing function that can serve as a clinically relevant platform to develop translational neuroregenerative strategies for RLN injury.
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Affiliation(s)
- Alexis Mok
- Department of Communication Science and Disorders, University of Missouri School of Health Professions, Columbia, MO, USA
| | - Jakob Allen
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Megan M Haney
- Department of Veterinary Pathobiology, University of Missouri College of Veterinary Medicine, Columbia, MO, USA
| | - Ian Deninger
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Brayton Ballenger
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Victoria Caywood
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Kate L Osman
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Bradford Zitsch
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Bridget L Hopewell
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Aaron Thiessen
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Marlena Szewczyk
- Department of Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Daniel Ohlhausen
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | | | - Emily Leary
- Department of Orthopedic Surgery, University of Missouri School of Medicine, Columbia, MO, USA
| | - Teresa E Lever
- Department of Otolaryngology - Head & Neck Surgery, University of Missouri School of Medicine, Columbia, MO, USA. .,One Hospital Dr. MA314, Columbia, MO, 65212, USA.
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5
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Xu X, Yang P, Zhuang P, Yanchao J, Yanli M, Schrof C, Jiang JJ. Study on Normal Laryngeal Electromyography of Thyroarytenoid Muscle, Cricothyroid Muscle, and Posterior Cricoarytenoid Muscle. Ann Otol Rhinol Laryngol 2018; 127:806-811. [PMID: 30187765 DOI: 10.1177/0003489418796525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the physiological activity of intrinsic laryngeal muscle under different functional states of larynx by measuring the normal laryngeal electromyography parameters. METHODS Laryngeal electromyography (EMG) was performed in 112 patients with unilateral vocal cord movement disorder. The duration and amplitude of the motor unit potential (MUP) of the thyroarytenoid muscle (TA), posterior cricoarytenoid muscle (PCA), and cricothyroid muscle (CT) were measured when patients were asked to make a deep inspiration and phonate /i/. The normal side of the patients' vocal chords was used as the research object. RESULTS (1) The motor unit potential of TA, CT, and PCA were measured when inspiration and phonating /i/. Waveforms were normal. (2) There were significant differences in duration of TA between inspiration and phonating /i/ in comfortable tone. (3) When comparing the duration and amplitude of any 2 of TA, CT, and PCA during inspiration and phonating /i/, there were significant differences in duration between CT and PCA when phonating /i/ only. There were no significant differences in any other comparisons. CONCLUSIONS Under either deep inspiration or pronunciation, the TA, CT, and PCA muscles were activated. The TA may play a major role in phonating. The PCA may play a major role in the action of deep inspiration.
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Affiliation(s)
- Xinlin Xu
- 1 Division of Otolaryngology, Xiamen University Zhongshan Hospital, Xiamen, Fujian, China
| | - Pan Yang
- 1 Division of Otolaryngology, Xiamen University Zhongshan Hospital, Xiamen, Fujian, China
| | - Peiyun Zhuang
- 1 Division of Otolaryngology, Xiamen University Zhongshan Hospital, Xiamen, Fujian, China
| | - Jiao Yanchao
- 1 Division of Otolaryngology, Xiamen University Zhongshan Hospital, Xiamen, Fujian, China
| | - Ma Yanli
- 1 Division of Otolaryngology, Xiamen University Zhongshan Hospital, Xiamen, Fujian, China
| | - Colin Schrof
- 2 Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jack J Jiang
- 2 Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
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Lin RJ, Smith LJ, Munin MC, Sridharan S, Rosen CA. Innervation status in chronic vocal fold paralysis and implications for laryngeal reinnervation. Laryngoscope 2018; 128:1628-1633. [DOI: 10.1002/lary.27078] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 10/25/2017] [Accepted: 12/04/2017] [Indexed: 11/11/2022]
Affiliation(s)
- R. Jun Lin
- Department of Otolaryngology-Head and Neck Surgery; University of Toronto, St. Michael's Hospital; Toronto Ontario Canada
| | - Libby J. Smith
- the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine; University of Pittsburgh
| | - Michael C. Munin
- the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine; University of Pittsburgh
- Department of Physical Medicine and Rehabilitation; University of Pittsburgh Medical Center; Pittsburgh Pennsylvania U.S.A
| | - Shaum Sridharan
- the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine; University of Pittsburgh
| | - Clark A. Rosen
- the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine; University of Pittsburgh
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Uludag M, Aygun N, Kartal K, Besler E, Isgor A. Innervation of the human posterior cricoarytenoid muscle by the external branch of the superior laryngeal nerve. Head Neck 2017; 39:2200-2207. [PMID: 28815834 DOI: 10.1002/hed.24896] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 04/17/2017] [Accepted: 06/15/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The posterior cricoarytenoid muscle is the abductor muscle for the vocal cords and is innerved by the recurrent laryngeal nerve (RLN). The purpose of this study was to present our determination if the external branch of the superior laryngeal nerve (SLN) contributes to the motor innervation of the posterior cricoarytenoid muscle. METHODS We performed electromyographies (EMGs) via needle electrodes on 47 posterior cricoarytenoid muscles from 28 patients during thyroidectomy (9 lobectomies and 19 total thyroidectomies) with intraoperative neural monitoring. The RLN, vagus nerve, and external branch of the SLN were stimulated intraoperatively and the responses were evaluated by EMG. RESULTS Positive EMG responses were obtained from 16 (34%) of 47 posterior cricoarytenoid muscles after external branch of the SLN stimulation. The EMG of the posterior cricoarytenoid muscle was unilaterally positive in 8 of 19 patients (42%) with total thyroidectomy, and 2 of 19 patients (10.5%) were bilaterally positive. CONCLUSION The external branch of the SLN contributes to the ipsilateral posterior cricoarytenoid muscle innervation in one-third of the cases. This contribution is usually unilateral, but is occasionally bilateral.
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Affiliation(s)
- Mehmet Uludag
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Nurcihan Aygun
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Kinyas Kartal
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Evren Besler
- Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Adnan Isgor
- Department of General Surgery, Bahcesehir University Medical Faculty, Istanbul, Turkey
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Raslan A, Volk GF, Möller M, Stark V, Eckhardt N, Guntinas-Lichius O. High variability of facial muscle innervation by facial nerve branches: A prospective electrostimulation study. Laryngoscope 2016; 127:1288-1295. [PMID: 27753086 DOI: 10.1002/lary.26349] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/16/2016] [Accepted: 09/12/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To examine by intraoperative electric stimulation which peripheral facial nerve (FN) branches are functionally connected to which facial muscle functions. STUDY DESIGN Single-center prospective clinical study. METHODS Seven patients whose peripheral FN branching was exposed during parotidectomy under FN monitoring received a systematic electrostimulation of each branch starting with 0.1 mA and stepwise increase to 2 mA with a frequency of 3 Hz. The electrostimulation and the facial and neck movements were video recorded simultaneously and evaluated independently by two investigators. RESULTS A uniform functional allocation of specific peripheral FN branches to a specific mimic movement was not possible. Stimulation of the whole spectrum of branches of the temporofacial division could lead to eye closure (orbicularis oculi muscle function). Stimulation of the spectrum of nerve branches of the cervicofacial division could lead to reactions in the midface (nasal and zygomatic muscles) as well as around the mouth (orbicularis oris and depressor anguli oris muscle function). Frontal and eye region were exclusively supplied by the temporofacial division. The region of the mouth and the neck was exclusively supplied by the cervicofacial division. Nose and zygomatic region were mainly supplied by the temporofacial division, but some patients had also nerve branches of the cervicofacial division functionally supplying the nasal and zygomatic region. CONCLUSIONS FN branches distal to temporofacial and cervicofacial division are not necessarily covered by common facial nerve monitoring. Future bionic devices will need a patient-specific evaluation to stimulate the correct peripheral nerve branches to trigger distinct muscle functions. LEVEL OF EVIDENCE 4 Laryngoscope, 127:1288-1295, 2017.
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Affiliation(s)
- Ashraf Raslan
- Department of Otorhinolaryngology and Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Gerd Fabian Volk
- Department of Otorhinolaryngology and Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Martin Möller
- Department of Otorhinolaryngology and Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
| | - Vincent Stark
- University of Applied Sciences Technikum Wien, Vienna, Austria
| | | | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology and Facial Nerve Center Jena, Jena University Hospital, Jena, Germany
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9
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Pascual-Font A, Cubillos L, Vázquez T, McHanwell S, Sañudo JR, Maranillo E. Are the interarytenoid muscles supplied by branches of both the recurrent and superior laryngeal nerves? Laryngoscope 2016; 126:1117-22. [DOI: 10.1002/lary.25375] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Arán Pascual-Font
- Department of Human Anatomy and Embryology I; School of Medicine, Complutense University of Madrid (A.P-F., L.C., T.V., J.R.S., E.M.); Madrid Spain
| | - Luis Cubillos
- Department of Human Anatomy and Embryology I; School of Medicine, Complutense University of Madrid (A.P-F., L.C., T.V., J.R.S., E.M.); Madrid Spain
| | - Teresa Vázquez
- Department of Human Anatomy and Embryology I; School of Medicine, Complutense University of Madrid (A.P-F., L.C., T.V., J.R.S., E.M.); Madrid Spain
| | - Steve McHanwell
- School of Medical Education, Newcastle University (S.M.); Newcastle United Kingdom
| | - José R. Sañudo
- Department of Human Anatomy and Embryology I; School of Medicine, Complutense University of Madrid (A.P-F., L.C., T.V., J.R.S., E.M.); Madrid Spain
| | - Eva Maranillo
- Department of Human Anatomy and Embryology I; School of Medicine, Complutense University of Madrid (A.P-F., L.C., T.V., J.R.S., E.M.); Madrid Spain
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10
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Abstract
BACKGROUND There is growing evidence that the external branch of the superior laryngeal nerve (eSLN) participates in thyroarytenoid (TA) contraction, but little data quantify its role in vocal cord adduction. Injury to the eSLN, such as in thyroid surgery, is difficult to diagnose and likely underappreciated. It is the authors' belief that eSLN injury contributes to aspiration by depriving its contribution to the laryngeal plexus. The goal of this study was to measure the glottic closing force (GCF) from eSLN stimulation in a porcine model. METHODS The recurrent laryngeal nerve (RLN) and eSLN were identified bilaterally in four porcine necks. Bilateral RLNs and eSLNs were stimulated simultaneously to obtain a control GCF using a pressure transducer placed in the glottis. Subsequently, bilateral eSLNs were stimulated and the GCF measured to quantify its percent contribution to the control value. RESULTS Stimulation of the RLNs and the eSLNs each led to TA muscle contraction and a measureable GCF in all four porcine necks. The control GCF was 1000.1 mmHg, while the eSLN mediated CGF was 800 mmHg. The percentage GCF attributable to the eSLN was thus 800/1000 = 80%. CONCLUSIONS Reflex glottic closure is one of the most important mechanisms for the prevention of aspiration during deglutition. The biomechanical quantification of glottic closure can be shown as the GCF. This study has shown that the eSLN contributes in a significant way to the GCF in a porcine model, a finding that has not been quantified to the best of the authors' knowledge. Therefore, greater focus should be placed on preserving this nerve in thyroid surgery.
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Affiliation(s)
- David Folk
- Yale Larynx Laboratory, Department of Surgery, Section of Otolaryngology, Yale School of Medicine, New Haven, Connecticut
| | - Basim Wahba
- Department of Otolaryngology, Cairo University of Egypt, Cairo, Egypt
| | - Clarence T. Sasaki
- Yale Larynx Laboratory, Department of Surgery, Section of Otolaryngology, Yale School of Medicine, New Haven, Connecticut
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11
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Bijangi-Vishehsaraei K, Blum K, Zhang H, Safa AR, Halum SL. Microarray Analysis Gene Expression Profiles in Laryngeal Muscle After Recurrent Laryngeal Nerve Injury. Ann Otol Rhinol Laryngol 2015; 125:247-56. [PMID: 26530091 DOI: 10.1177/0003489415608866] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The pathophysiology of recurrent laryngeal nerve (RLN) transection injury is rare in that it is characteristically followed by a high degree of spontaneous reinnervation, with reinnervation of the laryngeal adductor complex (AC) preceding that of the abducting posterior cricoarytenoid (PCA) muscle. Here, we aim to elucidate the differentially expressed myogenic factors following RLN injury that may be at least partially responsible for the spontaneous reinnervation. METHODS F344 male rats underwent RLN injury (n = 12) or sham surgery (n = 12). One week after RLN injury, larynges were harvested following euthanasia. The mRNA was extracted from PCA and AC muscles bilaterally, and microarray analysis was performed using a full rat genome array. RESULTS Microarray analysis of denervated AC and PCA muscles demonstrated dramatic differences in gene expression profiles, with 205 individual probes that were differentially expressed between the denervated AC and PCA muscles and only 14 genes with similar expression patterns. CONCLUSIONS The differential expression patterns of the AC and PCA suggest different mechanisms of reinnervation. The PCA showed the gene patterns of Wallerian degeneration, while the AC expressed the gene patterns of reinnervation by adjacent axonal sprouting. This finding may reveal important therapeutic targets applicable to RLN and other peripheral nerve injuries.
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Affiliation(s)
| | - Kevin Blum
- Purdue University Weldon School of Biomedical Engineering, West Lafayette, Indiana, USA
| | - Hongji Zhang
- Department of Pharmacology and Toxicology, Indiana University, Indianapolis, Indiana, USA
| | - Ahmad R Safa
- Department of Pharmacology and Toxicology, Indiana University, Indianapolis, Indiana, USA
| | - Stacey L Halum
- Department of Speech, Language, and Hearing Sciences, Purdue University, West Lafayette, Indiana, USA
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12
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Folk D, Paskhover B, Wadie M, Wahba B, Sasaki CT. External Branch of the Superior Laryngeal Nerve Mediated Glottic Closing Force in the Porcine Model. Ann Otol Rhinol Laryngol 2015; 125:421-4. [DOI: 10.1177/0003489415614865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Based on our laboratory’s newly confirmed motor pathway for glottic closure, we measured the glottic closing force (GCF) during isolated stimulation of the external branch of the superior laryngeal nerve (eSLN) in the porcine model. Glottic closure is 1 of the primary mechanisms for prevention of aspiration during deglutition. Methods: The recurrent laryngeal nerve (RLN) and eSLN were identified bilaterally in 4 porcine necks. Subsequently, GCF was measured with a pressure transducer as the distal ends of individual nerves were stimulated in 4 animals. The RLN mediated GCF was measured first, followed by isolated eSLN mediated GCF, followed by transection of the RLN and repeat measurement of the eSLN GCF. Ultimately, the cricothyroid (CT) muscle attachment was released and the GCF measured. Results: The GCF during isolated eSLN stimulation before and after RLN transection is approximately 89% of the RLN mediated GCF in each animal. The GCF after CT release is approximately 84% of the RLN perceived GCF. Transection of the RLN did not alter the eSLN observed GCF. Conclusions: The GCF obtained during isolated eSLN stimulation is adequate for delivery of an appropriate laryngeal protective response and may be considered a target motor nerve for augmenting GCF in selected rehab settings.
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Affiliation(s)
- David Folk
- Section of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Boris Paskhover
- Section of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mikhail Wadie
- Department of Otolaryngology, Cairo University of Egypt, Cairo, Egypt
| | - Basim Wahba
- Department of Otolaryngology, Cairo University of Egypt, Cairo, Egypt
| | - Clarence T. Sasaki
- Section of Otolaryngology, Yale School of Medicine, New Haven, Connecticut, USA
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13
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Paniello RC, Rich JT, Debnath NL. Laryngeal adductor function in experimental models of recurrent laryngeal nerve injury. Laryngoscope 2015; 125:E67-72. [PMID: 25283381 PMCID: PMC4304997 DOI: 10.1002/lary.24947] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/12/2014] [Accepted: 09/04/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Most patients with unilateral vocal fold paralysis experience some degree of spontaneous reinnervation, which depends upon the type and severity of recurrent laryngeal nerve (RLN) injury. After partial recovery, the paretic vocal fold may or may not adduct adequately to allow glottic closure, which in turn affects phonatory and swallowing outcomes. This process was studied in a series of canine laryngeal nerve injury models. STUDY DESIGN Animal (canine) experiments. METHODS Maximum stimulable laryngeal adductor pressure (LAP) was measured pretreatment (baseline) and at 6 months following experimental RLN injuries (total n = 59). The nine study groups were designed to simulate a range of severities of RLN injury. RESULTS The greatest LAP recovery, at 108% of original baseline, was seen in a 50% transection model; the least recovery was seen when the RLN underwent complete transection with repair, at 56% with precise alignment and 50% with alignment reversed. Intermediate models (partial RLN injuries) gave intermediate results. Crush models recovered 105% of LAP, whereas a half-transection, half-crush injury recovered 72%, and cautery injuries recovered 61%. Controls (complete transection without repair) had no measurable recovery. CONCLUSIONS The injured RLN has a strong tendency to recover. Restoration of adductor strength, as determined by the LAP, was predictably related to the severity of RLN injury. The model RLN injuries studied provide a range of expected outcomes that can be used for future experiments exploring interventions that may improve postinjury adductor function. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Randal C Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington University, St. Louis, Missouri, U.S.A; the St. Louis Veterans Affairs Medical Center, St. Louis, Missouri, U.S.A
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14
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Mattsson P, Hydman J, Svensson M. Recovery of laryngeal function after intraoperative injury to the recurrent laryngeal nerve. Gland Surg 2015; 4:27-35. [PMID: 25713777 PMCID: PMC4321052 DOI: 10.3978/j.issn.2227-684x.2015.01.10] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 01/26/2015] [Indexed: 11/14/2022]
Abstract
Loss of function in the recurrent laryngeal nerve (RLN) during thyroid/parathyroid surgery, despite a macroscopically intact nerve, is a challenge which highlights the sensitivity and complexity of laryngeal innervation. Furthermore, the uncertain prognosis stresses a lack of capability to diagnose the reason behind the impaired function. There is a great deal of literature considering risk factors, surgical technique and mechanisms outside the nerve affecting the incidence of RLN paresis during surgery. To be able to prognosticate recovery in cases of laryngeal dysfunction and voice changes after thyroid surgery, the surgeon would first need to define the presence, location, and type of laryngeal nerve injury. There is little data describing the events within the nerve and the neurobiological reasons for the impaired function related to potential recovery and prognosis. In addition, very little data has been presented in order to clarify any differences between the transient and permanent injury of the RLN. This review aims, from an anatomical and neurobiological perspective, to provide an update on the current understandings of surgically-induced injury to the laryngeal nerves.
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Affiliation(s)
- Per Mattsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Hydman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Svensson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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15
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Paskhover B, Wadie M, Sasaki CT. Thyroarytenoid cross-innervation by the external branch of the superior laryngeal nerve in the porcine model. Laryngoscope 2014; 125:177-9. [DOI: 10.1002/lary.24888] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 07/02/2014] [Accepted: 07/24/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Boris Paskhover
- Section of Otolaryngology; Yale School of Medicine; New Haven Connecticut U.S.A
| | - Mikhail Wadie
- Department of Otolaryngology; Cairo University of Egypt; Cairo Egypt
| | - Clarence T. Sasaki
- Section of Otolaryngology; Yale School of Medicine; New Haven Connecticut U.S.A
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