Nonselective Reinnervation as a Primary or Salvage Treatment of Unilateral Vocal Fold Palsy

Abstract

OBJECTIVES/HYPOTHESIS: Demonstration of voice improvement and long-term stability following nonselective unilateral laryngeal reinnervation (ULR) in patients with unilateral vocal fold paralysis (UVFP) and severe denervation. A subgroup of patients on whom ULR was performed as a salvage technique following unsuccessful medialization was analyzed separately. STUDY DESIGN: Prospective cohort study. METHODS: The ansa cervicalis-recurrent laryngeal nerve anastomosis technique was performed in all patients. Pre- and postoperative voice analysis included voice questionnaires, voice assessment by senior laryngologists using the Hirano Voice Scale, and computer-assisted voice analysis at defined time points over the course of 36 months. Laryngeal electromyography (LEMG) and spirometry were performed before and 1 year after ULR. RESULTS: Significant linear improvement of mean voice quality over time was observed in the majority of parameters measured in 48 ULR patients and in eight ULR salvage patients. LEMG 1 year after ULR showed new recruitment. Mean voice quality remained stable during follow-up in all ULR patients and in the ULR salvage group. CONCLUSIONS: Nonselective ULR in UVFP is a reliable and stable therapeutic option for patients with high expectations concerning voice quality. The effect is stable in long-term results. It is also a viable option for patients in whom conventional voice surgery failed to improve voice quality. We therefore propose ULR as salvage option in UVFP. LEVEL OF EVIDENCE: 2b Laryngoscope, 130:1756-1763, 2020.