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Laryngeal Reinnervation for Unilateral Vocal Fold Paralysis

Vocal fold immobility due to laryngeal paralysis can often be treated by laryngeal reinnervation. The therapeutic effect is characterized by an muscle gain and a shift to the midline of the paralyzed vocal fold. Oftentimes, a permanent restoration of the voice funtion can be achieved. Here, you will get information on the techniques and indications.

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Surgical Techniques

There are two types of laryngeal reinnervation: selective and non-selecitve. Selective reinnervation aims to restore active movements of the vocal folds and is used to improve breathing in case of BVFP.

Non-selective reinnervation is used for treating hoarseness caused by UVFP with the two effects of muscle gain and medialization of the paralyzed vocal fold. Two different techniques are established:

  1. the transposition of a nerve-muscle pedicel onto the paralyzed vocal fold (after Harvey Tucker) and
  2. the microsurgical suture of a small motoric nerve next to the larynx onto the recurrent laryngeal nerve (ANSA-RLN-technique). 

The ANSA-RLN-technique can be applied already in early childhood, e.g. the age of three.

Am I suitable for a Laryngeal Reinnervation?

Laryngeal reinnervation can be considered if the UVFP is permanent. In generell, thats the case if no active movements can be observed after a time of twelve months. For UVFP of unknown origin - e.g. without a prior surgery - the procedure can be performed after the expiration of 24 months. 

You might not be a suitable candidate if you had a previous radiation theraby in the neck region. Also, prognosis tends to be limited in elderly patients due to a diminished regenerative activity of the nerves.

54-year-old woman with Right UVFP, 20 years after Thyroidectomy, Laryngeal Reinnervation (ANSA-RLN)

Endoscopy before surgery
Endoscopy 12 months after surgery
Voice recording prior to surgery
Voice recording 12 months after surgery
Voice range profile, pre- (red) vs. postoperative (green)

22-year-old woman with Left UVFP after Surgery to Aortic Arch, Laryngeal Reinnervation (ANSA-RLN)

Endosopy before surgery
Endoscopy six months after surgery
Voice recording before surgery
Voice recording 6 months after surgery

56-year-old man, with Left UVFP after Aortic Reconstructive Surgery, Laryngeal Reinnervation (ANSA-RLN)

Endoscopy before the surgery
Endoscopy 12 months after surgery
Voice recording prior to surgery
Voice recording 12 months after surgery
Voice range profile before (red) and after surgery (grün)

45-year-old woman, with Right UVFP after Decompression Surgery to Cervical Spine, Laryngeal Reinnervation (ANSA-RLN)

Endoscopy before surgery
Endoscopy 10 months after surgery
Voice recording before surgery
Voice recording 10 months after surgery
Voice range profile before (red) and after (green) surgery

50-year-old man with Right Idiopathic UVFP, Laryngeal Reinnervation (ANSA-RLN)

Endoscopy before surgery
Endoscopy 24 months after surgery
Voice recording before surgery
Voice recording two years after surgery
Voice range profile before (red) and after (green) surgery

What additional information might be relevant for you?

You will need some patience! Since the nerve endings need time to sprout and reach the laryngeal muscles, it may take up to six months untill your voice improves noticeably. Because of this delay, a resorbable filler is injected into the vocal fold during the procedure to have an imediate effect and to bridge that waiting time and. 

Do you need further advice?