Nerve-muscle pedicle flap implantation combined with arytenoid adduction.
OBJECTIVE
To describe a new technique of nerve-muscle pedicle (NMP) flap implantation combined with arytenoid adduction (AA) to treat dysphonia due to unilateral vocal fold paralysis and to examine postoperative vocal function.


METHODS
Retrospective review of clinical records.


METHODS
Tertiary academic center.


METHODS
Twenty-two consecutive patients underwent NMP flap implantation with AA and were followed up short term over a period of 1 to 6 months (mean, 2.9 months) and long term over a period of 7 to 36 months (mean, 21.4 months).


METHODS
An NMP flap was made using an ansa cervicalis branch and a piece of the sternohyoid muscle. A window was opened in the thyroid ala at the level of the vocal fold. Then, AA was performed and the NMP flap was securely implanted onto the thyroarytenoid muscle through the window under microscopic guidance.


METHODS
The maximum phonation time, mean airflow rate, pitch range, and acoustic parameters (jitter, shimmer, and harmonics to noise ratio) were evaluated before surgery and twice after surgery.


RESULTS
All parameters improved significantly after surgery (P < .01). The measurements for maximum phonation time, mean airflow rate, and harmonics to noise ratio were within normal ranges after surgery. Furthermore, the maximum phonation time and jitter were significantly improved after long-term follow-up compared with early postoperative measurements (P < .01 and P < .05, respectively).


CONCLUSIONS
Precise harvest of an NMP flap and its placement directly onto the thyroarytenoid muscle combined with AA provided excellent vocal function. The NMP method may have played a certain role in the improvement of postoperative vocal function, although further study with electromyographic examination is required to clarify the innervation status of the thyroarytenoid muscle.
Yumoto
Eiji
E
Department of Otolaryngology-Head and Neck Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, Japan 860-8556. yu6167@gpo.kumamoto-u.ac.jp
Sanuki
Tetsuji
T
Toya
Yutaka
Y
Kodama
Narihiro
N
Kumai
Yoshihiko
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001193:Arytenoid Cartilage / Q000601:surgery; D055154:Dysphonia / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007821:Laryngeal Muscles / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000637:transplantation*; D010699:Phonation; D012189:Retrospective Studies; D013127:Spinal Nerves / Q000637:transplantation*; D013524:Surgical Flaps / Q000294:innervation*; D014826:Vocal Cord Paralysis / Q000150:complications / Q000601:surgery*