Dynamic Laryngotracheal Closure for Aspiration: A Preliminary Report

Objectives/Hypothesis. To determine whether respiratory compromise from bilateral vocal fold impairment (paralysis) can be objectively alleviated by reinnervation and pacing.Methods. A patient with paramedian vocal folds and synkinesis had a tracheotomy for stridor after bilateral laryngeal nerve injury and Miller Fisher syndrome. One posterior cricoarytenoideus (PCA) received a nerve-muscle pedicle fitted with a perineural electrode for pacemaker stimulation. The airway was evaluated endoscopically and by spirometry for up to 1 year.Results. Bilateral vocal fold patency during quiet breathing was reversed to active vocal fold adduction during tracheal occlusion. Peak inspiratory flows (PIFs) were significantly higher (P < .001) after reinnervation. PIFs and glottic apertures increased further under stimulation (42 Hz, 1-4 mA, 42-400 lsec). although the differences were not significant.Conclusions. Based on our preliminary data, PCA reinnervation and pacing offer promise for amelioration of respiratory compromise after paradoxical adduction in bilateral vocal fold impairment.

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“…We used for the purpose a unit that has been previously successful in targeting RLNs for vocal fold adduction in aspirating patients. 10 …”

Section: Introductionmentioning

confidence: 99%

Improvement of respiratory compromise through abductor reinnervation and pacing in a patient with bilateral vocal fold impairment

Broniatowski

Grundfest‐Broniatowski

Hadley

et al. 2009

The Laryngoscope

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“…Left-sided, recurrent laryngeal nerve stimulation with an implantable stimulator using the helical electrodes designed for VNS devices was used experimentally to prevent aspiration in two stroke patients [52]. This on-command stimulation produces frank ipsilateral glottic closure, preventing aspiration with the glottic opening and remaining patent when the on-command stimulation is finished.…”

Section: Laryngopharyngeal Dysfunctionmentioning

confidence: 99%

Intraoperative and perioperative complications with a vagus nerve stimulation device

Fahy

2010

Journal of Clinical Anesthesia

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“…23 Stroke-related dysphagia affects approximately 500,000 patients in the United States, and half of these patients experience aspiration. 24 First described in 2001, the device consists of bipolar electrodes implanted surgically into a recurrent laryngeal nerve and a receiver-stimulator implanted subcutaneously.…”

Section: Laryngeal Nerve Stimulatormentioning

confidence: 99%

Non-cardiac implantable electrical devices: brief review and implications for anesthesiologists

Venkatraghavan

Chinnapa

Peng

et al. 2009

Can J Anesth/J Can Anesth

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Dynamic Laryngotracheal Closure for Aspiration: A Preliminary Report

Abstract: Based on the first two patients, paced laryngotracheal separation is clinically effective in controlling aspiration.

Cited by 33 publications

References 23 publications

Improvement of respiratory compromise through abductor reinnervation and pacing in a patient with bilateral vocal fold impairment

Improvement of respiratory compromise through abductor reinnervation and pacing in a patient with bilateral vocal fold impairment

Intraoperative and perioperative complications with a vagus nerve stimulation device

Non-cardiac implantable electrical devices: brief review and implications for anesthesiologists

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