Figure 1.
Intraoperative image of reinnervation of the bilateral PCA muscles using the left phrenic nerve.
The posteroinferior portion of the thyroid lamina was partially removed. All adductor branches of the RLN, including the thyroarytenoid branch, lateral cricoarytenoid branch, interarytenoid branch, and three abductor branches, were well exposed (A). All adductor branches of the RLN were sectioned, and three abductor branches were well protected (B). The distal stump of the left RLN was anastomosed to the left phrenic nerve. A free nerve graft was used as a bridge between the adductor trunk of the left intralaryngeal RLN and distal stump of the right RLN through a retrolaryngeal or retrotracheal tunnel (C). The proximal ends of the adductor branches of the right intralaryngeal RLN were implanted into the right PCA muscle belly by suturing the nerve epineurium with the PCA myolemma (D). a: Recurrent laryngeal nerve (RLN), b: Abductor branches; c: Interarytenoid branch; d: .Lateral cricoarytenoid branch; e: Thyroarytenoid branch; f: Posterior cricoarytenoid muscle; g: Lateral cricoarytenoid muscle; h: Thyroarytenoid muscle; i: Inferior horn of thyroid cartilage; j: Section of thyroid lamina; k: Phrenic nerve; l: Adductor trunk of the RLN; m: Free nerve graft; n: Trachea. The yellow arrow in Figure 1C: the anastomotic site between phrenic nerve and the distal end of left RLN trunk; The white arrow in Figure 1C: the anastomotic site between adductor trunk of left RLN and free nerve graft; The yellow arrow head in Figure 1D: the anastomotic site between free nerve graft and the distal end of right RLN trunk; The white arrow head in Figure 1D: the implantation site of the proximal ends of adductor branches of the right RLN.
Figure 2.
Preoperative and postoperative videostroboscopic findings.
Case No. 5 showed representative bilateral vocal fold paralysis. Preoperatively, the bilateral vocal folds were fixed in the paramedian position during inspiration (A). Severely incomplete glottic closure occurred during phonation (B). Six months postoperatively, the bilateral vocal folds abducted to an paramedian or intermediate position during inspiration (C) and adducted back to the near-midline position during phonation with moderate incomplete glottis closure (D).