Laryngeal reinnervation in unilateral vocal fold paralysis- case report and literature review

Abstract

Laryngeal reinnervation is the method of treatment in unilateral vocal fold paralysis. During the surgery an anastomosis between the main branch of ansa cervicalis and recurrent laryngeal nerve is formed. Regeneration of the nerve’s functional abilities is a long process, lasting from 4 to 6 months, up to a year. A 35 year-old male was admitted to the Department of Otolaryngology at Warsaw Medical University in order to undergo surgical removal of reoccurrence of Schwannoma in left cerebellopontine angle by translabyrinthine approach. Post-operative period was complicated with vagal nerve paralysis. The patient reported hoarseness, dysphagia and choking. Physical examination revealed left vocal fold immobilization in abducted position, saliva in piriform fossa and left-sided soft palate paralysis yet the patient was discharged home. 4 weeks after the surgery, the patient was admitted to the hospital again due to developing aspiration pneumonia. Augmentation of the left vocal fold with calcium hydroxyapatite was performed 2 months later. After this intervention temporary vocal improvement and choking frequency reduction was observed. Finally, the patient underwent laryngeal reinnervation with formation of ansa cervicalis main branch to recurrent laryngeal nerve anastomosis. Left vocal fold regained its functional abilities and the quality of the voice improved. Laryngovideostroboscopy performed 6 months later revealed mobilization of left vocal fold sufficient for proper glottis closure. The voice measures normalized and the swallowing improved. Conclusions This case report and analyzed data confirm that laryngeal reinnervation surgery in unilateral vocal fold paralysis helps achieve satisfactory effects in voice function and life quality.