European Archives of Oto-Rhino-Laryngology

, Volume 275, Issue 11, pp 2813–2816 | Cite as

Functional identification of abductor and adductor branches for laryngeal transplantation

  • Ewa Migacz
  • David Howard
  • Zdzisław Gajewski
  • Katarzyna Siewruk
  • Wojciech KukwaEmail author
Head & Neck



This is a feasibility study of functional identification of the abductor and adductor recurrent laryngeal nerve branches, which could be used in the donor’s larynx for functional laryngeal transplantation.


The study was performed on swine (n = 3) and human (n = 4) models of a donor larynx. The recurrent laryngeal nerve and its branches were found. Using stimulator, abductor and adductor branches were identified, and glottis closing and opening were captured with an endoscope.


The result was positive if two ENT specialists noticed at least one adduction and one abduction movement in the same subject. It was obtained in three out of three swine and three out of four humans.


This study shows a way of reinnervation of a transplanted larynx which might result in a functional organ. It describes the first step of the procedure: functional identification of the abductor and adductor branches of the recurrent laryngeal nerve in the donor before the larynx is excised for transplantation.


Larynx Microvascular reconstruction and transplant surgery Airway stenosis/reconstruction Laryngeal reinnervation 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

Video 1. Adductive movement of left vocal fold in human (MP4 5254 KB)

Video 2. Abductive movement of left vocal fold in human (MP4 7228 KB)

Video 3. Adductive movement of right vocal fold (upper part of picture) in swine (MP4 6586 KB)

Video 4. Abductive movement of right vocal fold (upper part of picture) in swine (MP4 4978 KB)


  1. 1.
    Narula TBP, Carding P, Hakim N, Rumsey N, Sokol D, Edwards S (2012) What other journals tell us. Laryngeal transplantation: working party final report, June 2011. Clinical Otolaryngol 37(1):53–55CrossRefGoogle Scholar
  2. 2.
    Krishnan G, Du C, Fishman JM, Foreman A, Lott DG, Farwell G, Belafsky P, Krishnan S, Birchall MA (2017) The current status of human laryngeal transplantation in 2017: a state of the field review. The Laryngoscope 127(8):1861–1868CrossRefGoogle Scholar
  3. 3.
    Grajek M, Maciejewski A, Giebel S, Krakowczyk L, Ulczok R, Szymczyk C, Wierzgon J, Szumniak R, Dobrut M, Oles K, Drozdowski P, Walczak D, Szpak-Ulczok S, Poltorak S (2017) First complex allotransplantation of neck organs: larynx, trachea, pharynx, esophagus, thyroid. A case report. Ann Surg Parathyr Glands 266:e19–e24CrossRefGoogle Scholar
  4. 4.
    Li Y, Garrett G, Zealear D (2017) Current treatment options for bilateral vocal fold paralysis: a state-of-the-art review. Clin Exp Otorhinolaryngol 10(3):203–212CrossRefGoogle Scholar
  5. 5.
    Zealear DL, Billante CR, Courey MS, Netterville JL, Paniello RC, Sanders I, Herzon GD, Goding GS, Mann W, Ejnell H, Habets AM, Testerman R, Van de Heyning P (2003) Reanimation of the paralyzed human larynx with an implantable electrical stimulation device. The Laryngoscope 113(7):1149–1156CrossRefGoogle Scholar
  6. 6.
    Mueller AH, Hagen R, Foerster G, Grossmann W, Baumbusch K, Pototschnig C (2016) Laryngeal pacing via an implantable stimulator for the rehabilitation of subjects suffering from bilateral vocal fold paralysis: a prospective first-in-human study. The Laryngoscope 126(8):1810–1816CrossRefGoogle Scholar
  7. 7.
    Li M, Chen S, Zheng H, Chen D, Zhu M, Wang W, Liu F, Zhang C (2013) Reinnervation of bilateral posterior cricoarytenoid muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis. PloS One 8(10):e77233CrossRefGoogle Scholar
  8. 8.
    Orestes MI, Chhetri DK, Berke G (2015) Selective reinnervation for bilateral vocal cord paralysis using the superior laryngeal nerve. The Laryngoscope 125(11):2547–2550CrossRefGoogle Scholar
  9. 9.
    Prades JM, Faye MB, Timoshenko AP, Dubois MD, Dupuis-Cuny A, Martin C (2006) Microsurgical anatomy of intralaryngeal distribution of the inferior laryngeal nerve. Surg Radiol Anat SRA 28(3):271–276CrossRefGoogle Scholar
  10. 10.
    Marina MB, Marie JP, Birchall MA (2011) Laryngeal reinnervation for bilateral vocal fold paralysis. Curr Opin Otolaryngol Head Neck Surg 19(6):434–438CrossRefGoogle Scholar
  11. 11.
    Lott DG (2014) What is the future of ‘organ transplantation’ in the head and neck? Curr Opin Otolaryngol Head Neck Surg 22 (5):429–435CrossRefGoogle Scholar
  12. 12.
    Lorenz RR, Hicks DM, Shields RW Jr, Fritz MA, Strome M (2004) Laryngeal nerve function after total laryngeal transplantation. Otolaryngol Head Neck Surg 131(6):1016–1018CrossRefGoogle Scholar
  13. 13.
    Farwell DG, Birchall MA, Macchiarini P, Luu QC, de Mattos AM, Gallay BJ, Perez RV, Grow MP, Ramsamooj R, Salgado MD, Brodie HA, Belafsky PC (2013) Laryngotracheal transplantation: technical modifications and functional outcomes. The Laryngoscope 123(10):2502–2508PubMedGoogle Scholar
  14. 14.
    Crumley RL (2000) Laryngeal synkinesis revisited. Ann Otol Rhinol Laryngol 109(4):365–371CrossRefGoogle Scholar
  15. 15.
    Crumley RL (1989) Laryngeal synkinesis: its significance to the laryngologist. Ann Otol Rhinol Laryngol 98(2):87–92CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology, Faculty of Medicine and DentistryMedical University of WarsawWarsawPoland
  2. 2.Royal National Throat, Nose and Ear HospitalLondonUK
  3. 3.Imperial NHS Trust HospitalsLondonUK
  4. 4.Department of Large Animal Diseases with the Clinic, Faculty of Veterinary MedicineWarsaw University of Life SciencesWarsawPoland

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