Abstract
Objective: Illustrate the first reported case of recurrent adductor spasmodic dysphonia (ADSD) after bilateral selective laryngeal adductor denervation-reinnervation (SLAD-R) surgery presenting with dystonia of the strap muscles and adductors of the larynx.
Method: A 40-year-old man presented with ADSD. The patient underwent a bilateral SLAD-R surgery 10 years ago after botulinum toxin failure. The laryngeal dystonia was quiescent until 2 years ago when the patient noted worsening tension in his voice temporally associated with muscle spasm of his anterior neck.
Results: The patient elected to undergo re-exploration of his neck with lysis of his ansa cervicalis reinnervation. The operation revealed bilaterally intact neurorrhaphies between the superior root of the ansa cervicalis and the distal recurrent laryngeal nerves. Electrical stimulation of the superior roots of the ansa cervicalis produced laryngeal adductor activity as evidenced by an electromyography nerve monitor and by palpation of the arytenoids cartilage. The neurorrhaphies were sectioned and postoperatively the patient’s dystonias immediately resolved.
Conclusion: We present a case of demonstrated functional activity of nerves used for reinnervation in SLAD-R surgery for spasmodic dysphonia. Unfortunately in this case, the disease recurred through aberrant activity mediated via the translocated ansa cervicalis nerves.
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