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Use of Direct Posterior Cricoarytenoid Stimulation in Laryngeal Paralysis

Use of Direct Posterior Cricoarytenoid Stimulation in Laryngeal Paralysis Abstract • There are several methods used to restore impaired respiratory and phonatory function to the paralyzed larynx; but none are satisfactory. After we critically reviewed all available methods, we proposed a technique to rehabilitate the bilaterally paralyzed larynx, using selective stimulation of the posterior cricoarytenoid (PCA) muscle. This technique has the following advantages over existing methods: (1) preservation of phonation, (2) less chance of aspiration than with arytenoidectomy, and (3) reversibility. Adaptation of existing biomedical technology used in conjunction with any of several methods of triggering with respiration would make this a practical method. After insertion of electrodes into the PCA muscle of anesthetized animal subjects, selective electrical stimulation of this muscle was successfully accomplished. A significant reproducible increase in glottic area was demonstrated. Applicability to those suffering from bilateral laryngeal denervation seems feasible and functionally superior to existing methods of rehabilitation. (Arch Otolaryngol 1984;110:88-92) References 1. Neel HB, Townsend GL, Devine KD: Bilateral vocal cord paralysis of undetermined etiology: Clinical course and outcome . Ann Otol Rhinol Laryngol 1972;81:514-519. 2. Huppler EG, Schmidt HW, Devine D, et al: Causes of vocal cord paralysis . Mayo Clinic Proc 1955;30:518-521. 3. Gorman JB, Woodward FD: Bilateral paralysis of the vocal cords: Management of 25 cases . South Med J 1965;58:34-38.Crossref 4. Serafini I: Restoration of laryngeal function after laryngectomy experimental research in animals . Adv Otorhinolaryngol 1969;16:95-122. 5. Frazier CH, Erb WH: Superior laryngeal nerve and superior pole in thyroidectomies . Ann Surg 1935;101:1353-1357.Crossref 6. Colledge L, Ballance C: Surgical treatment of paralysis of vocal cord and of paralysis of diaphragm . Br Med J 1927;1:553-559, 609-612.Crossref 7. Doyle JD, Brummett RE, Everts EC: Results of surgical section and repair of the recurrent laryngeal nerve . Laryngoscope 1967; 77:1245-1254.Crossref 8. Bernstein JJ, Buth L: Selectivity in the re-establishment of synapses in the superior cervical sympathetic ganglion of the cat . Exp Neurol 1961;4:59-60.Crossref 9. Fex S: Functioning remobilization of vocal cords in cats with permanent recurrent laryngeal nerve paresis . Acta Otolaryngol 1970;69:294-301.Crossref 10. Kirchner JA: Atrophy of laryngeal muscles in vagal paralysis . Laryngoscope 1966;76:1753-1765.Crossref 11. Jackson C: Ventriculocordectomy, new operation for cure of goitrous paralytic laryngeal stenosis . Arch Surg 1922;4:257-274.Crossref 12. Loré LM: A suggested operative procedure for the relief of stenosis in double abductor paralysis: An anatomic study . Ann Oto Rhinol Laryngol 1936;45:679-686. 13. Woodman DG, Pennington CL: Bilateral abductor paralysis . Ann Otol 1976;85:437-439. 14. Fischer ND: Preliminary report on an application of the motor function of the superior laryngeal nerve . Ann Otol 1952;61:352-353. 15. Freedman LM: Role of cricothyroid muscle in tension of vocal cords: Experimental study in dogs designed to release tension of vocal cords in bilateral recurrent laryngeal nerve paralysis . Laryngoscope 1956;66:574-581.Crossref 16. Dedo HH, Ogura JH: Vocal cord electromyography in the dog . Laryngoscope 1965;74:201-210. 17. Tucker HM: Human laryngeal reinnervation . Laryngoscope 1976;86:769-779.Crossref 18. May M, Lavorato AS, Bleyaert AL: Rehabilitation of the crippled larynx: Application of the Tucker technique for muscle-nerve reinnervation . Laryngoscope 1980;90:1-18.Crossref 19. Tucker HM: Vocal cord paralysis—1979: Etiology and management . Laryngoscope 1980; 90:585-590.Crossref 20. Biller HF, Lawson W: Arytenoidectomy, arytenoidectopexy and the valved tube , in Snow JD, Jr (ed): Controversy in Otolaryngology . Philadelphia, WB Saunders Co, 1980, pp 37-42. 21. Rice DH, Owens O, Burstein, et al: The nerve-muscle pedical: A visual electromyographic and histochemical study . Arch Otolaryngol 1983;109:233-234.Crossref 22. Saul A, Bergstrom B: A new permanent tracheostomy tube-speech valve system . Laryngoscope 1979;89:980-983.Crossref 23. Sasaki CT, Milmoe G, Yanagiasawa E, Berry K, et al: Surgical closure of the larynx for intractable aspiration . Arch Otolaryngol 1980; 106:422-423.Crossref 24. Lindeman RC: Diverting the paralyzed larynx: A reversible procedure for intractable aspiration . Laryngoscope 1975;85:157-180.Crossref 25. Montgomery WW: Surgery to prevent aspiration . Arch Otolaryngol 1975;106:679-682.Crossref 26. Liberson WT, Holmquest HJ, Scot D, et al: Functional electrotherapy: Stimulation of peroneal nerve synchronized with the swing phase of the gait of hemiplegic patients . Arch Phys Med Rehabil 1961;42:101-105. 27. Glenn WW, Holcomb WG, Shaw RK, et al: Long-term ventilatory support by diaphragm pacing in quadriplegia . Ann Surg 1976;183:566-577.Crossref 28. Zealear DL, Dedo HH: Control of paralyzed axial muscles by electrical stimulation . Trans Am Acad Ophthalmol Otolaryngol 1977;84:310. 29. Tobey DN, Sutton D: Contralaterally elicited electrical stimulation of paralyzed facial muscles . Otolaryngol Head Neck Surg 1978; 89:812-818. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology American Medical Association

Use of Direct Posterior Cricoarytenoid Stimulation in Laryngeal Paralysis

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References (35)

Publisher
American Medical Association
Copyright
Copyright © 1984 American Medical Association. All Rights Reserved.
ISSN
0003-9977
DOI
10.1001/archotol.1984.00800280022007
Publisher site
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Abstract

Abstract • There are several methods used to restore impaired respiratory and phonatory function to the paralyzed larynx; but none are satisfactory. After we critically reviewed all available methods, we proposed a technique to rehabilitate the bilaterally paralyzed larynx, using selective stimulation of the posterior cricoarytenoid (PCA) muscle. This technique has the following advantages over existing methods: (1) preservation of phonation, (2) less chance of aspiration than with arytenoidectomy, and (3) reversibility. Adaptation of existing biomedical technology used in conjunction with any of several methods of triggering with respiration would make this a practical method. After insertion of electrodes into the PCA muscle of anesthetized animal subjects, selective electrical stimulation of this muscle was successfully accomplished. A significant reproducible increase in glottic area was demonstrated. Applicability to those suffering from bilateral laryngeal denervation seems feasible and functionally superior to existing methods of rehabilitation. (Arch Otolaryngol 1984;110:88-92) References 1. Neel HB, Townsend GL, Devine KD: Bilateral vocal cord paralysis of undetermined etiology: Clinical course and outcome . Ann Otol Rhinol Laryngol 1972;81:514-519. 2. Huppler EG, Schmidt HW, Devine D, et al: Causes of vocal cord paralysis . Mayo Clinic Proc 1955;30:518-521. 3. Gorman JB, Woodward FD: Bilateral paralysis of the vocal cords: Management of 25 cases . South Med J 1965;58:34-38.Crossref 4. Serafini I: Restoration of laryngeal function after laryngectomy experimental research in animals . Adv Otorhinolaryngol 1969;16:95-122. 5. Frazier CH, Erb WH: Superior laryngeal nerve and superior pole in thyroidectomies . Ann Surg 1935;101:1353-1357.Crossref 6. Colledge L, Ballance C: Surgical treatment of paralysis of vocal cord and of paralysis of diaphragm . Br Med J 1927;1:553-559, 609-612.Crossref 7. Doyle JD, Brummett RE, Everts EC: Results of surgical section and repair of the recurrent laryngeal nerve . Laryngoscope 1967; 77:1245-1254.Crossref 8. Bernstein JJ, Buth L: Selectivity in the re-establishment of synapses in the superior cervical sympathetic ganglion of the cat . Exp Neurol 1961;4:59-60.Crossref 9. Fex S: Functioning remobilization of vocal cords in cats with permanent recurrent laryngeal nerve paresis . Acta Otolaryngol 1970;69:294-301.Crossref 10. Kirchner JA: Atrophy of laryngeal muscles in vagal paralysis . Laryngoscope 1966;76:1753-1765.Crossref 11. Jackson C: Ventriculocordectomy, new operation for cure of goitrous paralytic laryngeal stenosis . Arch Surg 1922;4:257-274.Crossref 12. Loré LM: A suggested operative procedure for the relief of stenosis in double abductor paralysis: An anatomic study . Ann Oto Rhinol Laryngol 1936;45:679-686. 13. Woodman DG, Pennington CL: Bilateral abductor paralysis . Ann Otol 1976;85:437-439. 14. Fischer ND: Preliminary report on an application of the motor function of the superior laryngeal nerve . Ann Otol 1952;61:352-353. 15. Freedman LM: Role of cricothyroid muscle in tension of vocal cords: Experimental study in dogs designed to release tension of vocal cords in bilateral recurrent laryngeal nerve paralysis . Laryngoscope 1956;66:574-581.Crossref 16. Dedo HH, Ogura JH: Vocal cord electromyography in the dog . Laryngoscope 1965;74:201-210. 17. Tucker HM: Human laryngeal reinnervation . Laryngoscope 1976;86:769-779.Crossref 18. May M, Lavorato AS, Bleyaert AL: Rehabilitation of the crippled larynx: Application of the Tucker technique for muscle-nerve reinnervation . Laryngoscope 1980;90:1-18.Crossref 19. Tucker HM: Vocal cord paralysis—1979: Etiology and management . Laryngoscope 1980; 90:585-590.Crossref 20. Biller HF, Lawson W: Arytenoidectomy, arytenoidectopexy and the valved tube , in Snow JD, Jr (ed): Controversy in Otolaryngology . Philadelphia, WB Saunders Co, 1980, pp 37-42. 21. Rice DH, Owens O, Burstein, et al: The nerve-muscle pedical: A visual electromyographic and histochemical study . Arch Otolaryngol 1983;109:233-234.Crossref 22. Saul A, Bergstrom B: A new permanent tracheostomy tube-speech valve system . Laryngoscope 1979;89:980-983.Crossref 23. Sasaki CT, Milmoe G, Yanagiasawa E, Berry K, et al: Surgical closure of the larynx for intractable aspiration . Arch Otolaryngol 1980; 106:422-423.Crossref 24. Lindeman RC: Diverting the paralyzed larynx: A reversible procedure for intractable aspiration . Laryngoscope 1975;85:157-180.Crossref 25. Montgomery WW: Surgery to prevent aspiration . Arch Otolaryngol 1975;106:679-682.Crossref 26. Liberson WT, Holmquest HJ, Scot D, et al: Functional electrotherapy: Stimulation of peroneal nerve synchronized with the swing phase of the gait of hemiplegic patients . Arch Phys Med Rehabil 1961;42:101-105. 27. Glenn WW, Holcomb WG, Shaw RK, et al: Long-term ventilatory support by diaphragm pacing in quadriplegia . Ann Surg 1976;183:566-577.Crossref 28. Zealear DL, Dedo HH: Control of paralyzed axial muscles by electrical stimulation . Trans Am Acad Ophthalmol Otolaryngol 1977;84:310. 29. Tobey DN, Sutton D: Contralaterally elicited electrical stimulation of paralyzed facial muscles . Otolaryngol Head Neck Surg 1978; 89:812-818.

Journal

Archives of Otolaryngology – American Medical Association

Published: Feb 1, 1984

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