The natural history of recoverable vocal fold paralysis: Implications for kinetics of reinnervation

Mau, Ted; Pan, Hao; Childs, Lesley F.

doi:10.1002/lary.26734

Cited by 44 publications

(49 citation statements)

References 38 publications

(77 reference statements)

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“…Mau et al have proposed a time to recovery model created with the assumption that recovery in VFP occurs via two distinct recovery mechanisms (“early” and “late”) derived from the Seddon classification . The resulting bimodal distribution of recovery fits the VFP population of combined iatrogenic and idiopathic etiology in their study.…”

Section: Discussionmentioning

confidence: 99%

Time Course of Recovery of Iatrogenic Vocal Fold Paralysis

et al. 2018

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Objective To clarify the time course of recovery in patients with iatrogenic vocal fold paralysis. Study Design Retrospective chart review. Methods Medical records for all patients with iatrogenic vocal fold paralysis over a 10‐year period were reviewed to obtain demographic and clinical information, including onset of disease and recovery of vocal function. Stroboscopic exams of patients who recovered voice were reviewed blindly to assess return of vocal fold motion. Results One hundred and two patients of 114 (89%) recovered vocal function. Time to recovery could be assessed in 39 patients who did not undergo injection augmentation. The mean time to recovery was 181.8 ± 109.3 days (left: 166.4 ± 106.7 days; right: 221.8 ± 115.6 days; P value = 0.095). Patients were analyzed according to anatomical site of surgery (skull base, carotid endarterectomy, thoracic, neck and intubation); there was no significant difference in time to recovery (P value = 0.60). Twelve of the 39 patients had recovery of vocal fold motion. The mean time to vocal recovery did not differ between patients with return of motion versus no return of motion (140.6 ± 118.0 days vs. 200.1 ± 102.2 days; P value = 0.147). Conclusion Age, gender, laterality, and anatomical site of injury do not influence recovery rate in iatrogenic vocal fold paralysis. The probability of recovery decreases over time but more slowly in comparison with idiopathic vocal fold paralysis, reflecting the greater heterogeneity of injury type in the iatrogenic population. Commonly available aggregate recovery rates overstate the potential for recovery. Level of Evidence 4 Laryngoscope, 129:1159–1163, 2019

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Section: Discussionmentioning

confidence: 99%

Time Course of Recovery of Iatrogenic Vocal Fold Paralysis

et al. 2018

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“…The study was approved by the institutional review boards of the two respective institutions. Data analyzed in this work include those already published as well as data not previously published. Data collection methods were detailed in the published works and are briefly summarized here.…”

Section: Methodsmentioning

confidence: 99%

“…The conceptual framework for modeling is detailed in Mau et al The key elements are recapitulated here. Based on the Seddon classification of peripheral nerve injury, recovery from a focal RLN axonal injury was assumed to take place in an “early” recovery group that sustained neuropraxia, versus a “late” recovery group with axonotmesis or neurotmesis.…”

Section: Methodsmentioning

confidence: 99%

“…The aim of this study was to determine if the presentation of IVFP is consistent with an etiology due to a focal axonal lesion. Specifically, the time course of vocal recovery in IVFP was compared to a previously developed mathematical model based on expected recovery from a focal axonal lesion . Based on the known contrast with the presentation of iatrogenic vocal fold paralysis, we hypothesized that vocal recovery from IVFP would not fit the focal lesion model.…”

Section: Introductionmentioning

confidence: 99%

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Pathophysiology of iatrogenic and idiopathic vocal fold paralysis may be distinct

2019

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Objective: Spontaneous vocal recovery from idiopathic vocal fold paralysis (VFP) appears to differ in time course from recovery in iatrogenic VFP. This study aimed to determine if this difference could be explained by differing mechanisms causing recurrent laryngeal nerve (RLN) dysfunction, specifically whether idiopathic VFP is consistent with a focal RLN axonal lesion.Study Design: Case series with mathematical modeling.Methods: A review of 1267 cases of unilateral VFP over a 10-year period yielded 114 subjects (35 idiopathic, 79 iatrogenic) with a discrete onset of spontaneous vocal recovery. The time-to-recovery data were fit to a previously described two-phase model that incorporates the Seddon classification of neuropraxia and higher grades of axonal injury. Alternatively, the data were fit to a single phase model that does not assume a focal axonal lesion.Results: Time to vocal recovery in iatrogenic VFP can be reliably modeled by the assumption of a focal axonal lesion, with an early recovery group corresponding to neuropraxia and a late recovery group with more severe nerve damage. Time to recovery in idiopathic VFP can be more simply modeled in a single phase, with a time course that mirrors those in diverse biological processes such as transcription and microtubule growth.Conclusion: Idiopathic VFP may not be caused by a focal axonal lesion. Neuritis may be a compatible mechanism. The iatrogenic VFP data lend further support to the concept that the severity of RLN injury, not the length of axon to regenerate, is the chief determinant of recovery time after iatrogenic injury.

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“…However, injection augmentation or medialization thyroplasty are better suited to correct more anterior located glottic insufficiencies, rather than the more difficult to correct posterior glottic insufficiencies [13][14][15][16]. Although arytenoid adduction or arytenopexy have proven their value to correct posterior glottic insufficiency in patients with unilateral hemilaryngeal immobility, such procedures addressing the arytenoid's position can be challenging to perform and will not be performed, while there is still chance of spontaneous recovery, during which period (approximately 9 months) dysphonia persists [25]. Furthermore, they cannot be performed in cases with mobile vocal folds without sacrificing arytenoid mobility or in cases of crico-arytenoid fixation.…”

Section: Therapeutic Options For Posterior Glottic Insufficiencymentioning

confidence: 99%

Superomedial partial arytenoidectomy for voice improvement by correction of posterior glottic insufficiency

Mahieu

Heuveling

Mahieu

2020

Eur Arch Otorhinolaryngol

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Purpose Arytenoid resection is a well-known intervention to improve glottic airway. Superomedial partial arytenoidectomy (SPA) can also be used for voice improvement by correcting posterior glottic insufficiency in patients with an obstructing anteromedially prolapsed arytenoid. Posterior glottic insufficiency can be difficult to address and traditionally involves challenging arytenoid repositioning procedures. This study aimed to compare postoperative functional voice outcomes in patients who underwent SPA to pre-operative voice status. Second, consequences of concomitant injection augmentation in patients who underwent SPA were studied. Additionally, presenting the surgical technique. Methods In this retrospective cohort study, pre-operative and postoperative clinical data of patients who underwent SPA between 2004 and 2018 were analyzed. Both short-and long-term voice outcomes were assessed using Voice Handicap Index (VHI) and maximum phonation time (MPT). Pre-to postoperative assessment changes (delta: δ) were applied to multivariate analyses. Results A total of 105 patients were included, of which 91 had hemilaryngeal immobility, 25 had undergone previous phonosurgical procedures and 45 received concomitant injection augmentation. Patients who underwent SPA had significant improvement of VHI and MPT. In 81% of our population, laryngeal framework surgery was avoided. Multivariate analyses showed significantly improved short-term voice outcomes in patients who received injection augmentation concomitantly to SPA. Finally, δMPT was a significant predicting factor regarding additional procedures in patients who underwent SPA. Conclusion SPA is a safe and efficient procedure for voice improvement in patients with posterior glottic insufficiency due to an obstructing anteromedially prolapsed arytenoid. We recommend performing this procedure combined with injection augmentation.

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The natural history of recoverable vocal fold paralysis: Implications for kinetics of reinnervation

Abstract: 4. Laryngoscope, 127:2585-2590, 2017.

Cited by 44 publications

References 38 publications

Time Course of Recovery of Iatrogenic Vocal Fold Paralysis

Time Course of Recovery of Iatrogenic Vocal Fold Paralysis

Pathophysiology of iatrogenic and idiopathic vocal fold paralysis may be distinct

Superomedial partial arytenoidectomy for voice improvement by correction of posterior glottic insufficiency

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