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Systematic review and meta-analysis of laryngeal reinnervation techniques in adults with unilateral and bilateral vocal fold palsies

Published online by Cambridge University Press:  20 November 2023

Anjola Onifade Open the ORCID record for Anjola Onifade [Opens in a new window] ,
Elizabeth Vincent  and
Neil Tolley
Anjola Onifade*
Affiliation:
Imperial College London, London, UK
Elizabeth Vincent
Affiliation:
University Hospitals Sussex, Brighton, UK
Neil Tolley
Affiliation:
Imperial Healthcare NHS Trust, London, UK
*
Corresponding author: Anjola Onifade; Email: anjola.onifade@nhs.net
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Abstract

Objective

To evaluate the outcomes of reinnervation techniques for the treatment of adult unilateral vocal fold paralysis and bilateral vocal fold paralysis.

Methods

A literature review was conducted in the Embase and Medline databases in English, with no limitations on the publication date. The outcome parameters of interest included visual, subjective perceptual, acoustic, aerodynamic analysis and electromyography. A meta-analysis with a random-effects model and inverse variance was calculated.

Results

The systematic Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach resulted in 27 studies, totalling 803 patients (747 unilateral cases and 56 bilateral cases). Thyroid cancer and/or surgery had caused unilateral vocal fold paralysis in 74.8 per cent of cases and bilateral vocal fold paralysis in 69.6 per cent of cases. Statistically significant improvements in patients were observed for voice, deglutition and decannulation (bilateral vocal fold paralysis). Meta-analysis of 10 reinnervation techniques was calculated for the maximum phonation time of 184 patients.

Conclusion

Reinnervation was shown to improve voice, swallowing and decannulation, but studies lacked control groups, limiting generalisability. Larger studies with controls are needed.

Keywords

Humansadultelectromyographydeglutitionvocal cord paralysisthyroid neoplasmsphonationacoustics
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 138 , Issue 7 , July 2024 , pp. 732 - 746
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Anjola Onifade takes responsibility for the integrity of the content of the paper

Presented at the World Congress on Thyroid Cancer 2023, 15–17 June 2023, London, UK.

References

Misono, S, Merati, AL. Evidence-based practice: evaluation and management of unilateral vocal fold paralysis. Otolaryngol Clin North Am 2012;45:1083–108CrossRefGoogle ScholarPubMed
Fancello, V, Nouraei, SR, Heathcote, KJ. Role of reinnervation in the management of recurrent laryngeal nerve injury: current state and advances. Curr Opin Otolaryngol Head Neck Surg 2017;25:480–5CrossRefGoogle ScholarPubMed
IntHout, J, Ioannidis, JP, Rovers, MM, Goeman, JJ. Plea for routinely presenting prediction intervals in meta-analysis. BMJ Open 2016;6:e010247CrossRefGoogle ScholarPubMed
Howick, J, Chalmers, I, Glasziou, P, Greenhalgh, T, Heneghan, C, Liberati, A et al. OCEBM Levels of Evidence. Oxford: Centre for Evidence-Based Medicine, University of Oxford, 2021Google Scholar
Miyauchi, A, Inoue, H, Tomoda, C, Fukushima, M, Kihara, M, Higashiyama, T et al. Improvement in phonation after reconstruction of the recurrent laryngeal nerve in patients with thyroid cancer invading the nerve. Surgery 2009;146:1056–62CrossRefGoogle ScholarPubMed
Paniello, RC. Laryngeal reinnervation with the hypoglossal nerve II. Clinical evaluation and early patient experience. Laryngoscope 2000;110:739–48CrossRefGoogle ScholarPubMed
Chou, F-F, Su, C-Y, Jeng, S-F, Hsu, K-L, Lu, K-Y. Neurorrhaphy of the recurrent laryngeal nerve. J Am Coll Surg 2003;197:52–7CrossRefGoogle ScholarPubMed
Smith, ME, Roy, N, Stoddard, K. Ansa-RLN reinnervation for unilateral vocal fold paralysis in adolescents and young adults. Int J Pediatr Otorhinolaryngol 2008;72:1311–16CrossRefGoogle ScholarPubMed
Su, W-F, Hsu, Y-D, Chen, H-C, Sheng, H. Laryngeal reinnervation by ansa cervicalis nerve implantation for unilateral vocal cord paralysis in humans. J Am Coll Surg 2007;204:64–72CrossRefGoogle ScholarPubMed
Sanuki, T, Yumoto, E, Minoda, R, Kodama, N. The role of immediate recurrent laryngeal nerve reconstruction for thyroid cancer surgery. J Oncol 2010;2010:846235CrossRefGoogle ScholarPubMed
Li, M, Chen, S, Zheng, H, Chen, D, Zhu, M, Wang, W et al. Reinnervation of bilateral posterior cricoarytenoid muscles using the left phrenic nerve in patients with bilateral vocal fold paralysis. PLoS One 2013;8:e77233CrossRefGoogle ScholarPubMed
Lee, SW, Park, KN, Oh, SK, Jung, C-H, Mok, J-O, Kim, C-H. Long-term efficacy of primary intraoperative recurrent laryngeal nerve reinnervation in the management of thyroidectomy-related unilateral vocal fold paralysis. Acta Otolaryngol 2014;134:1179–84CrossRefGoogle ScholarPubMed
Li, M, Zheng, H, Chen, S, Chen, D, Zhu, M. Selective reinnervation using phrenic nerve and hypoglossal nerve for bilateral vocal fold paralysis. Laryngoscope 2019;129:2669–73CrossRefGoogle ScholarPubMed
Ab Rani, A, Azman, M, Ubaidah, MA, Yunus, MRM, Sani, A, Baki, MM. Nonselective laryngeal reinnervation versus type 1 thyroplasty in patients with unilateral vocal fold paralysis: a single tertiary centre experience. J Voice 2021;35:487–92CrossRefGoogle ScholarPubMed
Wang, W, Chen, D, Chen, S, Li, D, Li, M, Xia, S et al. Laryngeal reinnervation using ansa cervicalis for thyroid surgery-related unilateral vocal fold paralysis: a long-term outcome analysis of 237 cases. PLoS One 2011;6:e19128CrossRefGoogle ScholarPubMed
Candelo, E, Borsetto, D, Obholzer, R, Clarke, P, MatBaki, M, Birchall, M. Functional outcomes following delayed laryngeal reinnervation of patients with vagal paralysis after paraganglioma and schwannoma surgery. J Voice 2023;37:610–15CrossRefGoogle ScholarPubMed
Lorenz, RR, Esclamado, RM, Teker, AM, Strome, M, Scharpf, J, Hicks, D et al. Ansa cervicalis-to-recurrent laryngeal nerve anastomosis for unilateral vocal fold paralysis: experience of a single institution. Ann Otol Rhinol Laryngol 2008;117:40–5CrossRefGoogle ScholarPubMed
Lee, WT, Milstein, C, Hicks, D, Akst, LM, Esclamado, RM. Results of ansa to recurrent laryngeal nerve reinnervation. Otolaryngol Head Neck Surg 2007;136:450–4CrossRefGoogle ScholarPubMed
Crumley, RL. Update: ansa cervicalis to recurrent laryngeal nerve anastomosis for unilateral laryngeal paralysis. Laryngoscope 1991;101:384–8CrossRefGoogle ScholarPubMed
May, M, Beery, Q. Muscle-nerve pedicle laryngeal reinnervation. Laryngoscope 1986;96:1196–200CrossRefGoogle ScholarPubMed
El-Kashlan, HK, Carroll, WR, Hogikyan, ND, Chepeha, DB, Kileny, PR, Esclamado, RM. Selective cricothyroid muscle reinnervation by muscle-nerve-muscle neurotization. Arch Otolaryngol Head Neck Surg 2001;127:1211–15CrossRefGoogle ScholarPubMed
Buyukatalay, ZC, Brisebois, S, Sirin, S, Merati, AL. Does dysphagia improve following laryngeal reinnervation for treatment of hoarseness in unilateral vocal fold paralysis? J Voice 2021;35:307–11CrossRefGoogle ScholarPubMed
Baki, MM, Clarke, P, Birchall, M. Immediate selective laryngeal reinnervation in vagal paraganglioma patients. J Laryngol Otol 2018;132:846–51CrossRefGoogle Scholar
Maronian, N, Robinson, L, Waugh, P, Hillel, A. Electromyographic findings in recurrent laryngeal nerve reinnervation. Ann Otol Rhinol Laryngol 2003;112:314–23CrossRefGoogle ScholarPubMed
Mansor, WNW, Azman, M, Remli, R, Yunus, MRM, Baki, MM. Primary nonselective laryngeal reinnervation in iatrogenic acute recurrent laryngeal nerve injury: case series and literature review. Ear Nose Throat J 2023;102:164–9CrossRefGoogle ScholarPubMed
Olson, DE, Goding, GS, Michael, DD. Acoustic and perceptual evaluation of laryngeal reinnervation by ansa cervicalis transfer. Laryngoscope 1998;108:1767–72CrossRefGoogle ScholarPubMed
Zheng, H, Li, Z, Zhou, S, Cuan, Y, Wen, W. Update: laryngeal reinnervation for unilateral vocal cord paralysis with the ansa cervicalis. Laryngoscope 1996;106:1522–7CrossRefGoogle ScholarPubMed
Kodama, N, Sanuki, T, Kumai, Y, Yumoto, E. Long-term vocal outcomes of refined nerve-muscle pedicle flap implantation combined with arytenoid adduction. Eur Arch Otorhinolaryngol 2015;272:681–8CrossRefGoogle ScholarPubMed
Wang, W, Liu, F, Zhang, C, Li, M, Chen, S, Gao, Y et al. Immediate ansa cervicalis-to-recurrent laryngeal nerve anastomosis for the management of recurrent laryngeal nerve infiltration by a differentiated thyroid carcinoma. ORL J Otorhinolaryngol Relat Spec 2020;82:93–105CrossRefGoogle ScholarPubMed
Egger, M, Smith, GD, Schneider, M, Minder, C. Bias in meta-analysis detected by a simple, graphical test. Br Med J 1997;315:629–34CrossRefGoogle ScholarPubMed
Sterne, JA, Egger, M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 2001;54:1046–55CrossRefGoogle ScholarPubMed
Harrer, M, Cuijpers, P, Furukawa, T, Ebert, D. Doing Meta-analysis with R: A Hands-on Guide. Boca Raton, FL: Chapman and Hall/CRC, 2021CrossRefGoogle Scholar
Rothstein, HR, Sutton, AJ, Borenstein, M. Publication bias in meta-analysis: Prevention, assessment and adjustments. Chichester: Wiley, 2005;1–7CrossRefGoogle Scholar
Bartoš, F, Maier, M, Quintana, DS, Wagenmakers, E-J. Adjusting for publication bias in JASP and R: selection models, PET-PEESE, and robust Bayesian meta-analysis. Adv Methods Pract Psychol Sci 2022;5Google Scholar
Yuan, Q, Hou, J, Liao, Y, Zheng, L, Wang, K, Wu, G. Selective vagus-recurrent laryngeal nerve anastomosis in thyroidectomy with cancer invasion or iatrogenic transection. Langenbecks Arch Surg 2020;405:461–8CrossRefGoogle ScholarPubMed
Manni, J. Laryngeal reinnervation with the hypoglossal nerve. Laryngoscope 2001;111:1113–14CrossRefGoogle ScholarPubMed
Blackshaw, H, Carding, P, Jepson, M, Baki, MM, Ambler, G, Schilder, A et al. Does laryngeal reinnervation or type I thyroplasty give better voice results for patients with unilateral vocal fold paralysis (VOCALIST): study protocol for a feasibility randomised controlled trial. BMJ Open 2017;7:e016871CrossRefGoogle ScholarPubMed
Lagier, A, Polle-Pelletier, V, Giovanni, A, Marie, J. Vocal fold medialization: which are the available fillers in France in 2010. Eur Ann Otorhinolaryngol Head Neck Dis 2011;128:99–101CrossRefGoogle ScholarPubMed
Laccourreye, O, Papon, JF, Kania, R, Crevier-Buchman, L, Brasnu, D, Hans, S. Intracordal injection of autologous fat in patients with unilateral laryngeal nerve paralysis: long-term results from the patient's perspective. Laryngoscope 2003;113:541–5CrossRefGoogle ScholarPubMed
Mallur, PS, Rosen, CA. Vocal fold injection: review of indications, techniques, and materials for augmentation. Clin Exp Otorhinolaryngol 2010;3:177–82CrossRefGoogle ScholarPubMed
Zeleník, K, Walderová, R, Kučová, H, Jančatová, D, Komínek, P. Comparison of long-term voice outcomes after vocal fold augmentation using autologous fat injection by direct microlaryngoscopy versus office-based calcium hydroxylapatite injection. Eur Arch Otorhinolaryngol 2017;274:3147–51CrossRefGoogle ScholarPubMed