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Treatment of unilateral vocal fold paralysis with ansa cervicalis to recurrent nerve anastomosis in a young adolescent: European case report

Published online by Cambridge University Press:  29 June 2018

C van den Boer ,
A L Wiersma ,
J P Marie  and
J T van Lith-Bijl
C van den Boer*
Affiliation:
Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands
A L Wiersma
Affiliation:
Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands
J P Marie
Affiliation:
Otolaryngology – Head and Neck Surgery Department, Rouen University Hospital, France
J T van Lith-Bijl
Affiliation:
Department of Otorhinolaryngology, Academic Medical Center, Amsterdam, the Netherlands Department of Otorhinolaryngology, Flevo Hospital, Almere, the Netherlands
*
Author for correspondence: Dr Cindy van den Boer, Department of Otorhinolaryngology, Academic Medical Center, Meibergdreef 9, Postbus 22660, 1100 DD Amsterdam, the Netherlands E-mail: c.vandenboer@amc.nl Fax: +31 20 691 3850
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Abstract

Background

Laryngeal re-innervation in paediatric unilateral vocal fold paralysis is a relatively new treatment option, of which there has been little reported experience in Europe.

Methods

In this European case report of a 13-year-old boy with dysphonia secondary to left-sided unilateral vocal fold paralysis after cardiac surgery, the patient underwent re-innervation using an ansa cervicalis to recurrent laryngeal nerve transfer, in combination with fat augmentation, after 12 years of nerve denervation. Perceptual analysis data, and acoustic and laryngoscopy recordings were acquired pre-operatively, and at one and two years post-operatively.

Results

The patient's perceptual voice quality was improved. He experienced subjective improvement and is very satisfied with the result. As expected, laryngoscopy at one and two years after surgery showed no physiological mobility of the vocal fold concerned, but improved closure during phonation was achieved. Electromyography showed evidence of re-innervation.

Conclusion

Laryngeal re-innervation could be considered as a treatment option for unilateral vocal fold paralysis in children and adolescents, even after a long-term delay.

Keywords

Laryngeal Nerve InjuriesVocal Cord ParalysisRecurrent Laryngeal NerveSurgeryAdolescentSpeech Therapy
Type
Clinical Record
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 7 , July 2018 , pp. 661 - 664
Copyright
Copyright © JLO (1984) Limited, 2018 

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Footnotes

Dr C van den Boer takes responsibility for the integrity of the content of the paper

Presented at the Annual Meeting of the Dutch Society of Otorhinolaryngology and Head and Neck Surgery, 21 April 2017, Nieuwegein, the Netherlands, and at the Pan-European Voice Conference, 1 September 2017, Ghent, Belgium.

References

1Butskiy, O, Mistry, B, Chadha, NK. Surgical interventions for pediatric unilateral vocal fold paralysis – a systematic review. JAMA Otolaryngol Head Neck Surg 2015;141:654–60Google Scholar
2Setlur, J, Hartnick, CJ. Management of unilateral true vocal cord paralysis in children. Curr Opin Otolaryngol Head Neck Surg 2012;20:497–501Google Scholar
3Grover, N, Bhattacharyya, A. Unilateral pediatric vocal cord paralysis: evolving trends. J Laryngol Voice 2012;1:5–9Google Scholar
4Sipp, JA, Kerschner, JE, Braune, N, Hartnick, CJ. Vocal fold medicalization in children: injection laryngoplasty, thyroplasty, or nerve reinnervation? Arch Otolaryngol 2007;133:767–71Google Scholar
5Zur, KB, Carroll, LM. Recurrent laryngeal nerve reinnervation in children: acoustic and endoscopic characteristics pre-intervention and post-intervention. A comparison of treatment options. Laryngoscope 2015;125(suppl 11):S1–15Google Scholar
6Marcum, KK, Wright, SC Jr, Kemp, ES, Kitse, DJ. A novel modification of the ansa to recurrent laryngeal nerve reinnervation procedure for young children. Int J Pediatr Otorhinolaryngol 2010;74:1335–7Google Scholar
7Smith, ME, Houtz, DR. Outcomes of laryngeal reinnervation for unilateral vocal fold paralysis in children: associations with age and time since injury. Ann Otol Rhinol Laryngol 2016;125:433–8Google Scholar
8Farhood, Z, Reusser, NM, Bender, RW, Thekdi, AA, Albright, JT, Edmonds, JL. Pediatric recurrent laryngeal nerve reinnervation: a case series and analysis of post-operative outcomes. Int J Pediatr Otorhinolaryngol 2015;79:1320–3Google Scholar
9Lorenz, RR, Esclamado, RM, Teker, AM, Strome, M, Scharpf, J, Hicks, D et al. Ansa cervicalis-to-recurrent laryngeal nerve anastomosis for unilateral vocal fold paralysis: experience of a single institution. Ann Otol Rhinol Laryngol 2008;117:40–5Google Scholar
10Smith, ME, Roy, N, Stoddard, K. Ansa-RLN reinnervation for unilateral vocal fold paralysis in adolescents and young adults. Int J Pediatr Otorhinolaryngol 2008;72:1311–16Google Scholar
11Crumley, RI. Update: ansa cervicalis to recurrent laryngeal nerve anastomosis for unilateral laryngeal paralysis. Laryngoscope 1991;101:384–7Google Scholar
12Cohen, W, Wynne, DM, Kubba, H, McCartney, E. Development of a minimum protocol for assessment in the paediatric voice clinic. Part 1: evaluating vocal function. Logoped Phoniatr Vocol 2012;37:33–8Google Scholar
13Dejonckere, PH, Bradley, P, Clemente, P, Cornut, G, Crevier-Buchman, L, Friedrich, G. A basic protocol for functional assessment of voice pathology, especially for investigating the efficacy of (phonosurgical) treatments and evaluating new assessment techniques. Guideline elaborated by the Committee of Phoniatrics of the European Laryngological Society. Eur Arch Otorhinolaryngol 2001;258:77–82Google Scholar
14Marina, MB, Marie, JP, Birchall, MA. Laryngeal reinnervation for bilateral vocal fold paralysis. Curr Opin Otolaryngol Head Neck Surg 2011;19:434–8Google Scholar
15Lim, JY, Lim, SE, Choi, SH, Kim, JH, Kim, KM, Choi, HS. Clinical characteristics and voice analysis of patients with mutational dysphonia: clinical significance of diplophonia and closed quotients. J Voice 2005;21:12–19Google Scholar
16Pagano, R, Morsomme, D, Camby, S, Lejeune, L, Finck, C. Long-term results of 18 fat injections in unilateral vocal fold paralysis. J Voice 2017;31:505Google Scholar
17Cantarella, G, Mazzola, RF, Gaffuri, M, Lofrida, E, Biondetti, P, Forzenigo, LV et al. Structural fat grafting to improve outcomes of vocal folds’ fat augmentation: long-term results. Otolaryngol Head Neck Surg 2018;158:135–43Google Scholar
18van Lith-Bijl, JT, Mahieu, HF. Laryngeal reinnervation - results of a selective approach in an animal study. Indian J Otolaryngol Head Neck Surg 1997;49:203–8Google Scholar
19Rubin, AD, Sataloff, RT. Vocal fold paresis and paralysis. Otolaryngol Clin North Am 2007;40:1109–31Google Scholar

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