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Shay EO, Morrison RA, Zhang L, Kaefer SL, Wesson T, Cox A, Voytik-Harbin SL, Halum S. Scaffold-Forming Collagen and Motor-Endplate Expressing Muscle Cells for Porcine Laryngoplasty. Laryngoscope 2024. [PMID: 39011835 DOI: 10.1002/lary.31642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/15/2024] [Accepted: 07/02/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVE Vocal fold paralysis impairs quality of life, and no curative injectable therapy exists. We evaluated injection of a novel in situ polymerizing (scaffold-forming) collagen in the presence and absence of muscle-derived motor-endplate expressing cells (MEEs) to promote medialization and recurrent laryngeal nerve (RLN) regeneration in a porcine model of unilateral vocal fold paralysis. METHODS Twelve Yucatan minipigs underwent right RLN transection. Autologous muscle progenitor cells were isolated from muscle biopsies, differentiated, and induced to MEEs. Three weeks after RLN injury, animals received injections of collagen, collagen containing MEEs, or saline into the paralyzed right vocal fold. Stimulated laryngeal electromyography and acoustic vocalization were used for function assessments. Larynges were harvested and underwent histologic, gene expression, and further quantitative analyses. RESULTS Injections were well-tolerated, with the collagen scaffold showing immunotolerance and collagen-encapsulated MEEs remaining viable. Collagen-treated paralyzed vocal folds showed increased laryngeal adductor muscle volumes relative to that of the uninjured side, with those receiving MEEs and collagen showing the highest volumes. Muscles injected with MEEs and collagen demonstrated increased expression of select neurotrophic (BDNF and NTN1), motor-endplate (DOK7, CHRNA1, and MUSK), and myogenic (MYOG and MYOD) related genes relative to saline controls. CONCLUSION In a porcine model of unilateral vocal fold paralysis, injection of in situ polymerizing collagen in the absence and presence of MEEs enhanced laryngeal adductor muscle volume, modulated expression of neurotrophic and myogenic factors, and avoided adverse material-mediated immune responses. Further study is needed to determine long-term functional outcomes with this novel therapeutic approach. LEVEL OF EVIDENCE NA Laryngoscope, 2024.
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Affiliation(s)
- Elizabeth O Shay
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Rachel A Morrison
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, U.S.A
| | - Lujuan Zhang
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Samuel L Kaefer
- School of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Troy Wesson
- School of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Abigail Cox
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana, U.S.A
| | - Sherry L Voytik-Harbin
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, Indiana, U.S.A
| | - Stacey Halum
- Department of Otolaryngology-Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
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Ridgway C, Bouhabel S, Martignetti L, Kishimoto Y, Li-Jessen NYK. Pediatric Vocal Fold Paresis and Paralysis: A Narrative Review. JAMA Otolaryngol Head Neck Surg 2021; 147:745-752. [PMID: 34110365 DOI: 10.1001/jamaoto.2021.1050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Vocal fold paralysis (VFP) results from the disruption of neural motor outputs to laryngeal muscles. Children with VFP manifest various degrees of difficulties in phonation, breathing, and swallowing. Although the etiologic characteristics and symptoms of VFP are well established in adults, corresponding clinical profiles are notably different in children. Clinical management of VFP is particularly challenging in children because their larynges are still actively developing and the recovery of disrupted laryngeal nerves is often unpredictable. This review discusses the neurologic conditions and diagnostic and treatment considerations in pediatric VFP. Observations Injury to the peripheral laryngeal nerves and certain central nervous system diseases, such as Arnold-Chiari malformation type II, can result in VFP in infants and children. The incidence of unilateral vs bilateral VFP is variable across pediatric studies. Most reported VFP cases are associated with injury of the recurrent laryngeal nerve. Laryngeal electromyography requires needle insertion that must be performed under anesthesia with special care in the pediatric setting. Neither normative values nor standardized procedures of laryngeal electromyography are currently established for the pediatric population. Laryngeal reinnervation, endoscopic arytenoid abduction lateropexy, and laryngeal pacing are plausible treatment options for pediatric VFP. Despite these new advances in the field, no corresponding efficacy data are available for clinicians to discern which type of patients would be the best candidates for these procedures. Conclusions and Relevance The neuroanatomy and neurophysiology of VFP remain more elusive for the pediatric population than for adults. Basic and clinical research is warranted to fully comprehend the complexity of this laryngeal movement disorder and to better inform and standardize clinical practice.
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Affiliation(s)
- Chelsea Ridgway
- School of Communication Sciences and Disorders, McGill University, Montreal, Canada
| | - Sarah Bouhabel
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Canada
| | - Lisa Martignetti
- School of Communication Sciences and Disorders, McGill University, Montreal, Canada
| | - Yo Kishimoto
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University, Kyoto, Japan
| | - Nicole Y K Li-Jessen
- School of Communication Sciences and Disorders, McGill University, Montreal, Canada.,Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Canada.,Department of Biomedical Engineering, McGill University, Montreal, Canada
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Mau T. Understanding Risk and Recovery in Vocal Fold Paralysis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-021-00333-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Leclerc AA, Munin MC, Smith LJ, Rosen CA. Abnormal Laryngeal Electromyography Findings in Asymptomatic Adults Across the Age Spectrum. Laryngoscope 2020; 131:2065-2069. [PMID: 33125187 DOI: 10.1002/lary.29213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Laryngeal electromyography (LEMG) is a diagnostic tool for patients with suspected neurogenic abnormalities of the larynx. LEMG is often used with the assumption that any abnormality is symptom-/disease-related. We sought to determine the prevalence of abnormal LEMG findings in a group of healthy asymptomatic adults across a large age spectrum. STUDY DESIGN Open, prospective study, gender-match and age balanced by decade. METHODS Forty-six healthy participants (age 20-78) underwent LEMG, including 178 muscles. Participants had no history of voice problems, normal VHI-10, and normal flexible laryngoscopy. Qualitative and quantitative LEMG (bilateral) were performed involving the thyroarytenoid-lateral cricoarytenoid muscle complex (TA-LCA) and cricothyroid (CT) muscles. LEMG parameters included evaluation for fibrillation potentials, sharp waves, reduced recruitment, polyphasic potentials, electrical synkinesis, and measurement of turns per second. RESULTS Of participants, 4% had at least one abnormal qualitative finding (slightly reduced recruitment or two to three discrete polyphasic potentials). There were no findings of fibrillation potentials or sharp waves. There were no abnormal qualitative findings in the CT muscles tested. Of participants, 16% had at least one abnormal synkinesis finding. LEMG qualitative abnormalities and quantitative abnormalities do not appear to correlate with gender or age. CONCLUSION Abnormal qualitative and quantitative LEMG findings were uncommon and minor in severity in our group of asymptomatic healthy adults. The likelihood of abnormal LEMG results in asymptomatic adults was 2.2% for qualitative findings, 9.3% for synkinesis, and 5.4% for turns/s. LEVEL OF EVIDENCE 3 Laryngoscope, 131:2065-2069, 2021.
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Affiliation(s)
| | - Michael C Munin
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Libby J Smith
- UPMC Voice Center, Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Clark A Rosen
- UCSF Voice and Swallowing Center, Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, California, U.S.A
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Wang W, Sun J, Tang H, Gao Y, Chen S, Li M, Zheng H. Main branch of ACN-to-RLN for management of laryngospasm due to unilateral vocal cord paralysis. Laryngoscope 2019; 130:2412-2419. [PMID: 31782810 DOI: 10.1002/lary.28426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/12/2019] [Accepted: 11/04/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study explored the feasibility and efficiency of main branch of ansa cervicalis nerve (ACN)-to-recurrent laryngeal nerve (RLN) anastomosis for management of paroxysmal laryngospasm due to unilateral vocal cord paralysis (UVCP). METHODS Thirteen patients who underwent main branch of ACN-to-RLN anastomosis for management of paroxysmal laryngospasm due to UVCP were enrolled in the present study. Multidimensional assessments, including videostroboscopy, voice assessment, and laryngeal electromyography (LEMG), were performed preoperatively and postoperatively. RESULTS This series was limited to UVCP with iatrogenic causes, including thyroidectomy, cervical spine surgery, and thoracic surgery. After main branch of ACN-to-RLN anastomosis, all cases showed significant airway improvement, and laryngospasm was completely abolished in 92.3% (12 of 13) of cases. Videostroboscopy showed that the bulging and paradoxical adduction of the affected vocal cord during a sniff were abolished immediately after operation, and there was no significant difference in vocal fold position or glottal closure before versus after the operation. LEMG showed that the postoperative recruitment and amplitude of voluntary motor unit potential in the affected thyroarytenoid muscle during a sniff were significantly decreased compared to preoperative values, and postoperative recruitment showed significant improvement during phonation compared to that preoperatively. Voice assessment showed that there were no significant differences in overall grade, roughness, breathiness, jitter (local), shimmer (local), noise-to-harmonics ratio, or maximum phonation time after the operation compared to the preoperative values. CONCLUSIONS Main branch of ACN-to-RLN anastomosis could have long-lasting efficacy in the management of paroxysmal laryngospasm due to UVCP, with no apparent compromise of voice quality. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2412-2419, 2020.
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Affiliation(s)
- Wei Wang
- Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China
| | - Jianxiong Sun
- Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China
| | - Haihong Tang
- Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China
| | - Yingna Gao
- Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China
| | - Shicai Chen
- Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China
| | - Meng Li
- Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China
| | - Hongliang Zheng
- Department of Otolaryngology-Head & Neck Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, the People's Republic of China
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Bhatt NK, Faddis BT, Paniello RC. Laryngeal adductor function following potassium titanyl phosphate laser welding of the recurrent laryngeal nerve. Laryngoscope 2019; 130:1764-1769. [PMID: 31566750 DOI: 10.1002/lary.28295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/16/2019] [Accepted: 08/28/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Recurrent laryngeal nerve (RLN) transection injuries may occur during thyroidectomy and other surgical procedures. Laser nerve welding has been shown to cause less technique-related axonal damage than the traditional suture method. We compared functional adductor results using these two methods of RLN repair. STUDY DESIGN Animal model. METHODS Canine hemilarynges underwent pretreatment testing of laryngeal adductor function, followed by RLN transection and repair using potassium titanyl phosphate (KTP) laser welding (n = 8) or microneural suture (n = 16) techniques. Six months later, adductor function was measured again and expressed as a proportion of the pretreatment value. RESULTS The mean laryngeal adductor pressure ratios were 82.4% (95% confidence interval [CI]: 72.8%-92.0%) for the laser repair group and 55.5% (95% CI: 49.4%-61.6%) for the suture control group, with a difference of 26.9% (95% CI: 15.3%-38.5%). Both spontaneous and stimulated glottic closure was observed in the laser welding and microsuture repair groups. CONCLUSIONS Laser nerve welding resulted in greater strength of adduction than suture repair of an acutely transected RLN. Suture anastomosis may traumatize more axons than the laser. Stronger vocal fold adduction is associated clinically with better protection from aspiration and improved voice outcomes. KTP laser welding should be considered for anastomosis of the RLN and other nerves. LEVEL OF EVIDENCE NA Laryngoscope, 130:1764-1769, 2020.
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Affiliation(s)
- Neel K Bhatt
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Brian T Faddis
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
| | - Randal C Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St. Louis, Missouri, U.S.A
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Bhatt NK, Kao WTK, Paniello RC. Compound Motor Action Potential Measures Acute Changes in Laryngeal Innervation. Ann Otol Rhinol Laryngol 2018; 127:661-666. [DOI: 10.1177/0003489418784973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Vocal fold paralysis is caused by injury to the recurrent laryngeal nerve (RLN). Current clinical measures of laryngeal innervation are often nonquantitative. Compound motor action potentials (CMAP) measure motor innervation. The goal of this study was to determine whether CMAP can quantify laryngeal innervation following acute nerve injury. Study Design: Animal study. Methods: Twelve canine hemilaryngeal preparations were used. The RLN was serially stimulated with increasing intensities until the nerve was maximally stimulated. The CMAP amplitude was measured for each intensity stimulation and correlated. Next, the RLN was incompletely transected, and the reduction in CMAP amplitude was correlated to the percentage of transected axons. The percentage of transected axons was determined using horseradish peroxidase (HRP) staining. Results: Combining all hemilaryngeal preparations, the submaximal stimulation of the RLN linearly correlated with the resultant CMAP amplitude (r = 0.83; 95% CI, 0.76-0.88). Following partial RLN transection, the percentage of remaining axons linearly correlated with the CMAP amplitude (r = 0.87; 95% CI, 0.34-0.98). Conclusions: CMAP amplitude is a quantitative measure that may correlate with the degree of vocal fold innervation in canines. Following RLN injury, CMAP may help clinicians quantify the number of intact axons, assess the likelihood of recovery, and counsel patients on their prognosis.
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Affiliation(s)
- Neel K. Bhatt
- Department of Otolaryngology–Head and Neck Surgery, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Wee Tin K. Kao
- Department of Otolaryngology–Head and Neck Surgery, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Randal C. Paniello
- Department of Otolaryngology–Head and Neck Surgery, Washington University in Saint Louis, Saint Louis, Missouri, USA
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