Reinnervation/Pacing for Bilateral Vocal Fold Paralysis

Abstract

Standard therapy in patients with bilateral vocal fold paralysis (BVFP) still only focuses primarily on the improvement of the breathing function. Modern surgical options with the aim to restore at least partially the vocal fold movement should play a stronger role in the future. In recent years, a clear progress in the concepts of selective laryngeal reinnervation and in laryngeal neurostimulation (laryngeal pacing) can be seen. Patients with even long-lasting and permanent BVFP showing no signs of vocal fold movement are nowadays good candidates for laryngeal movement repair. Selective reinnervation can be established by a unilateral phrenic nerve transfer to both posterior cricoarytenoid (PCA) muscles using a Y-shaped auricular nerve graft in combination with a bilateral ansa to adductor branch anastomosis. Laryngeal pacing in its recent state of clinical trials preserves the typically found synkinetic reinnervated status of the larynx, is even feasible in patients with cricoarytenoid joint fixation, and achieves vocal fold abduction by electrical stimulation of terminal nerve fibers inside the PCA muscle. Ultrathin stimulation wires could be placed in an injection like minimally invasive surgical procedure, and the pulse generator is placed on the chest wall. These new therapy options have the potential to restore near-normal respiratory function without compromising voice and swallowing and may contribute to the development of larynx transplantation surgery.