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Laryngeal pacing in minipigs: in vivo test of a new minimal invasive transcricoidal electrode insertion method for functional electrical stimulation of the PCA

  • Laryngology
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Abstract

Functional electrical stimulation (FES) of the posterior cricoarytenoid muscle (PCA) to restore respiratory function of the larynx may become an option for the treatment of bilateral recurrent laryngeal nerve paralysis (RLNP) in the near future. The feasibility of this has been shown in several animal trials and in a human pilot study. The common open surgical inferolateral approach for electrode insertion into the PCA for FES has a risk of damaging the recurrent laryngeal nerve (RLN) and may result in postoperative swelling and scaring of the larynx. Therefore, a minimal invasive electrode insertion technique is needed. A new miniaturized bipolar spiral tip electrode and a new electrical stimulatable insertion needle were tested in a short-term trial for an endoscopically guided and functionally controlled transcricoidal electrode insertion in eight Göttingen minipigs with bilateral normal RLN function. The feasibility of this technique was evaluated and the achieved positions of the electrodes in the PCA were analyzed using intraoperative stimulation threshold data and 3D-CT reconstructions. In seven cases it was possible to place two well-performing electrodes into the PCA. They were positioned one on either side. In one animal no functioning electrode position could be achieved because the PCA was missed. Thresholds of the electrode tips varied between 0.2 and 2.5 mA (mean 0.71 mA). In any case maximal glottal opening could be reached before adductors were co-activated. The majority of electrodes were placed into the central lower part of the PCA with no apparent correlation between threshold and electrode position. Surgical trauma might be further reduced by using endoscopy via a laryngeal mask avoiding the temporary tracheostomy used in this trial. If the implanted electrodes remain stable in long-term tests, we suggest that this method could soon be transferred into human application.

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Acknowledgments

This work has been sponsored by Med-El Medical Electronics Innsbruck.

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Authors and Affiliations

  1. ENT Department, SRH Wald-Klinikum Gera, Gera, Germany

    Gerhard Förster & Andreas H. Müller

  2. Section for Motor Research, Pathophysiology and Biomechanics of University Hospital for Trauma-, Hand- and Reconstructive Surgery, Friedrich-Schiller-University Jena, Jena, Germany

    Dirk Arnold & Hans-Christoph Scholle

  3. Institute for Laboratory Animal Sciences and Welfare of Friedrich-Schiller-University Jena, Jena, Germany

    Sabine J. Bischoff & Harald Schubert

  4. ENT Department, SRH Wald-Klinikum Gera, 07548, Gera, Germany

    Gerhard Förster

Authors
  1. Gerhard Förster
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  2. Dirk Arnold
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  3. Sabine J. Bischoff
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  4. Harald Schubert
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  5. Hans-Christoph Scholle
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  6. Andreas H. Müller
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Correspondence to Andreas H. Müller.

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Förster, G., Arnold, D., Bischoff, S.J. et al. Laryngeal pacing in minipigs: in vivo test of a new minimal invasive transcricoidal electrode insertion method for functional electrical stimulation of the PCA. Eur Arch Otorhinolaryngol 270, 225–231 (2013). https://doi.org/10.1007/s00405-012-2141-1

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  • DOI: https://doi.org/10.1007/s00405-012-2141-1

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