Selective Laryngeal Adductor Denervationreinnervation: A New Surgical Treatment for Adductor Spasmodic Dysphonia

TLDR

Botulinum toxin is the standard treatment for adductor spasmodic dysphonia but requires repeated injections, has unpredictable dose–response, and can cause short‑term swallowing and voice problems. This study reports preliminary experience with a new surgical treatment for adductor spasmodic dysphonia. The procedure selectively denervates the adductor branch of the recurrent laryngeal nerve bilaterally and reinnervates the distal stumps with ansa cervicalis branches, and was performed on 21 patients with a median follow‑up of 36 months. Nineteen of 21 patients achieved absent to mild dysphonia, and only one required additional botulinum toxin, indicating promising efficacy of the new surgery.

Abstract

During the past decade, botulinum toxin (Botox) has emerged as the accepted treatment for adductor spasmodic dysphonia (ASD). This therapy, which produces bilateral weakness of the thyroarytenoid muscle, undoubtedly produces physiologic effects that are beneficial to patients with ASD. However, it also has important limitations, including the need for repeated injections, the unpredictable relationship between dosage and response, and the possibility of short-term swallowing and voice problems. In this study, we will report our preliminary experience with a new surgical treatment for ASD. In this new procedure, the adductor branch of the recurrent laryngeal nerve is selectively denervated bilaterally, and its distal nerve stumps are reinnervated with branches of the ansa cervicalis nerve. Each of the patients was followed for at least 12 months; the median follow-up is 36 months. The outcome of the operation in 21 consecutive patients is reported. Nineteen of the 21 patients were judged to have an overall severity of dysphonia that was “absent to mild” following the procedure. Only 1 patient underwent further treatment with Botox postoperatively. The implications of this new procedure for ASD are discussed.