Selective reinnervation for correction of unilateral paralysis of larynx in thyroidal surgery

Abstract

Objective. To estimate the possibility of performance of selective reinnervation of larynx in its abductionaal unilateral paralysis in thyroidal surgery.

Маterials and methods. There were analyzed the results of selective laryngeal reinnervation in 2 patients, suffering thyroidal cancer. Visual inspection of the larynx was conducted (fibrolaryngoscopy with archiving of the data) in preoperative and postoperative periods, аs well as in 2, 4, 6, 12, 18 and 24 mo postoperatively, spectral vocal analysis, estimation of vocal quality in accordance to the VHI-30 sсale reporting, using questionnaires ЕАТ-10 for determination of the dysphagia degree.

Results. Selective reinnervation was performed in 2 patients with extralaryngeal branching of nervus recurrence: in one - the postponed selective reinnervation of larynx (аutoplasty of the adduction branch of nervus recurrence) for correction of its postoperative abductional paralysis, and in the second - primary selective laryngeal reinnervation (аnastomosis of the adductional branch of nervus recurrence in the “end-to-end” style). In the first patient the tone and stretching of the paralyzed vocal cord free edge was registered in 15 mo after reinnervation, the coordinated move signs - in 2 yrs. In a second patient the restoration of tone and mobility of a vocal cord was registered in 4 mo after reinnervation. In both patients the main indices of the voice spectral analysis and of the self-estimation in accordance to the VHI-30 and ЕАТ-10 scales were restored up to normal values.

Conclusion. Selective reinnervation of larynx may be applied not for correction of respiratory disorders due to its bilateral paralysis only, but for restoration of a vocal function and elimination of aspiration symptoms in a case of unilateral paralysis of larynx as well.