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Dual laryngeal reinnervation in bilateral vocal fold paralysis: anatomical pitfalls

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Abstract

Background

Bilateral laryngeal reinnervation can be a promising procedure for reanimation of laryngeal muscles, but currently not yet standardized. Besides patient conditions some intraoperative anatomical pitfalls need to be solved.

Methods

Twelve human head and neck specimens (24 sides) have been studied using microdissection and histological serial sections of the nerves. The surgical anatomy of the dual reinnervation procedure according to JP Marie was investigated notably the branching pattern of the phrenic nerve (PN), the Ansa cervicalis (AC) and the recurrent laryngeal nerve (RLN).

Results

Despite variations of the AC, a prominent inferior common trunk for sterno-hyoid and sterno-thyroid muscles can be used in more than 90% of the specimens. If the AC is missing because of previous surgery, the tiny nerve of the thyro-hyoid muscle can be used preferred. The PN display a double roots pattern from C3 to C4 cervical plexus in 50% of the specimens. A single root pattern can be found and an end-to-lateral neurorraphy can be used. Intra-laryngeal nerves pattern of the RLN display tiny collaterals which cannot be selected for abduction–adduction activity. Direct implantation of the Y-shape great auricular nerve within the posterior crico-arytenoid muscles can be a reliable method leading to challenging mechanical and functional conditions.

Conclusion

Several anatomical pitfalls, including intra-operative choices and variants of the donor nerves, but also the challenging intra-laryngeal dissection of the inferior laryngeal nerve need to be solved. A successful laryngeal reinnervation still needs further studies for a simplified procedure.

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Acknowledgements

The authors confirm that there are no financial or other limitations that serve as a conflict of interest in this research. There were no financial support or research grants made available to support this research.

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Authors and Affiliations

  1. Laboratory of Human Anatomy, Faculty of Medicine, University of Saint-Etienne, Saint-Étienne, France

    Jean Michel Prades, Yann Lelonge, Marie Dominique Dubois & Marie Gavid

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Saint-Etienne, Saint-Étienne, France

    Jean Michel Prades, Yann Lelonge, Marie Dominique Dubois & Marie Gavid

  3. Laboratory of Pathology, Faculty of Medicine, University of Saint-Etienne, Saint-Étienne, France

    Jean Marc Dumollard & Michel Peoc’h

Authors
  1. Jean Michel Prades
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  2. Yann Lelonge
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  3. Marie Dominique Dubois
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  4. Jean Marc Dumollard
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  5. Michel Peoc’h
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  6. Marie Gavid
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Contributions

JMP: protocol development, data analysis, manuscript writing. JMD–MP: data collection, data analysis, manuscript writing. YL–MDD–MG: protocol development, data collection.

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Correspondence to Jean Michel Prades.

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Prades, J.M., Lelonge, Y., Dubois, M.D. et al. Dual laryngeal reinnervation in bilateral vocal fold paralysis: anatomical pitfalls. Surg Radiol Anat 43, 1745–1751 (2021). https://doi.org/10.1007/s00276-021-02698-6

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  • DOI: https://doi.org/10.1007/s00276-021-02698-6

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