title: Nerve-muscle transplantation to the paraglottic space after resection of recurrent laryngeal nerve.
abstract: OBJECTIVE
  To evaluate a new method of nerve-muscle transplantation (NMT) to the paraglottic space after resection of the recurrent laryngeal nerve (RLN) during surgery for thyroid cancer.
  
  
  METHODS
  Review of nine consecutive patients with RLN paralysis caused by the thyroid cancer before surgery.
  
  
  METHODS
  After the usual extirpation of the thyroid cancer with concomitant removal of the RLN, the lower part of the sternohyoid muscle approximately 1 cm in width and 2 cm in length with the ansa cervicalis nerve connected was inserted into the paraglottic space by way of anterior retraction of the thyroid ala with the inferior horn cut off. When the muscle or the nerve was adhesive to the cancer, the nerve-muscle on the opposite side was used with transfer through the space under the thyrohyoid muscles and the superior horn of thyroid ala.
  
  
  RESULTS
  The voice quality was good or fair after surgery. In most patients, the maximum phonation time was 10 seconds or longer, and the mean flow rate was lower than 200 mL/s. The vocal functions were good immediately after surgery and maintained good values for 2 years or more after surgery. Vocal fold atrophy was not found in any patient.
  
  
  CONCLUSIONS
  When the RLN is resected during surgery for thyroid cancer end-to-end anastomosis of the nerve is impossible, NMT to the paraglottic space is a useful method for preserving good voice and preventing atrophy of the vocal fold.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Shinzo
authors.initials: S
authors.lastname: Tanaka
authors.forename: Ryo
authors.initials: R
authors.lastname: Asato
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Hiratsuka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation / Q000637:transplantation*; D012009:Recurrent Laryngeal Nerve / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000601:surgery*; D014833:Voice Quality