Abstract
The author sought to achieve laryngeal reinnervation, with or without arytenoid adduction (AA), to treat severe breathy dysphonia caused by unilateral vocal fold paralysis. One surgical approach is primary reconstruction of the recurrent laryngeal nerve (RLN) immediately after extirpation of a thyroid or other malignant tumor. The RLN is reconstructed via direct suturing, interpolation of a free nerve graft between the severed stumps of the RLN, or transfer of the ansa cervicalis nerve (ACN). Another strategy features delayed reinnervation of the larynx in combination with AA. Nerve–muscle pedicle flap implantation into the thyroarytenoid muscle (a technique refined by the author) will also be described. This technique and nerve transfer involving the ACN both deliver excellent vocal function several months postoperatively. Laryngeal edema after AA attains its maximum extent on postoperative day (POD) 3 and then gradually (and significantly) subsides to POD 7. Both AA and type I thyroplasty negatively affect respiratory functioning, although no patient experienced dyspneic symptoms when performing daily activities.
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