REINNERVATION AS A METHOD OF TREATMENT OF ONE-SIDED ABDUCTION LARYNX PARALYSIS IN OPERATIONS ON THYROID GLAND

Abstract

Introduction. The use of selective larynx reinnervation creates the prerequisites for the resumption of synchronous mobility of the vocal folds and is used to correct breathing problems in the case of bilateral laryngeal paralysis, but it can be used to correct unilateral abduction paralysis during an operation on the thyroid gland. Objective: To assess the possibility of performing selective larynxreinnervation during abduction unilateral paralysis in thyroid surgery. Materials and methods: All patients underwent examination of the larynx (fibrolaryngoscopy with data archiving) before and after operation, as well as 4, 6,12,18 months after operation, voice spectral analysis, voice quality assessment (VHI-30), EAT-10 survey (determining the degree of dysphagia). Results. Selective reinnervation was carried out in 2 groups of patients with non-peel-shaped branching of RLN. Group 1 (1 patient) with pre-existing postoperative unilateral laryngeal abduction paralysis, severe dysphonic and moderate aspiration disorders, delayed selective larynx reinnervation was performed (autoplasty of the RLN adduction branch using n. transversus colli fragment). Group 2 (1 patient) performed primary selective larynx reinnervation in connection with resection of the adduction branch of the RLN (tumor invasion into it). An anastomosis of the end-to-end RLN branch of the RLN was performed with three epiperineural sutures. In a patient of group 1, a change in the tone and tension of the free edge of the «paralyzed» vocal fold was recorded 15 months after reinnervation, and the first signs of coordinated movement — after 18 months — fully recovered in almost 2 years. In a patient of group 2, the restoration of the tone of the «paralyzed» vocal fold and the restoration of its mobility were recorded 4 months after larynx reinnervation. In both patients, there was a recovery of the main indicators of the spectral analysis of the voice to normal values, as well as a decrease in the indices (points) of dysphagia on the EAT-10 scale and the index of voice disorders on the VHI-30 scale to normal. Conclusions: Selective larynx reinnervation is applicable not only to eliminate respiratory failure with bilateral laryngeal paralysis, but also to restore voice function, to eliminate the symptoms of aspiration in unilateral laryngeal paralysis. Taking into account the statistical unreliability of the groups of this research and the complexity of this methodology in practical application, it requires further study and a multidisciplinary approach.