Implantation of Contralaterally Harvested Nerve-Muscle Pedicle Flap Combined with Arytenoid Adduction for Paralytic Dysphonia

Abstract

Objectives:

1) Describe operative procedures to reinnervate the thyroarytenoid muscle (TA) on the paralyzed side using a modified nerve-muscle pedicle (NMP) flap implantation harvested on the contralateral side combined with arytenoid adduction (AA). 2) Assess time-dependent improvement in vocal function during postoperative follow-up.

Methods:

Prospective case series. Four patients underwent modified NMP flap implantation combined with AA for paralytic dysphonia between August 2009 and January 2013. The NMP flap was harvested on the contralateral side because of scar formation on the paralyzed side and was secured to the TA under microscopic control. Three of them were followed over one year, and their voice outcomes, determined by 5 objective and 2 subjective parameters, were evaluated preoperatively and at 4 different time points after surgery.

Results:

On average, maximum phonation time and mean airflow rate improved from 5.4s and 569mL/s preoperatively to 24.2s and 116mL/s 12 months postoperatively, respectively. Jitter, shimmer, and harmonics-to-noise ratio also improved from 10.5%, 16.4%, and 4.2dB preoperatively to 1.7%, 11.2%, and 6.8dB postoperatively, respectively. Grade overall and breathiness of GRBAS scale became much better from 2.6 and 2.4 preoperatively to 0.2 and 0.0 12 months postoperatively, respectively. Stroboscopic images together with voice during follow-up period will be presented.

Conclusions:

Combination of AA and a modified NMP flap implantation harvested on the contralateral side improves long-term voice outcomes of paralytic dysphonia. Therefore, patients in whom the ansa cervicalis nerve is unavailable due to high level scar formation could have a great benefit by these operative methods.