title: Laryngeal reinnervation featuring refined nerve-muscle pedicle implantation evaluated via electromyography and use of coronal images.
abstract: OBJECTIVE
  To evaluate the long-term efficacy of laryngeal reinnervation via refined nerve-muscle pedicle (NMP) flap implantation combined with arytenoid adduction to treat unilateral vocal fold paralysis (UVFP), employing laryngeal electromyography (LEMG), coronal imaging, and phonatory function assessment.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  We retrospectively reviewed 12 UVFP patients who underwent refined NMP implantation with arytenoid adduction. Videostroboscopy, phonatory functional analysis, LEMG, and coronal imaging were performed before and 2 years after surgery. In LEMG analysis, a 4-point scale was employed to grade motor unit (MU) recruitment: 4+ reflected no recruitment, 3+ greatly decreased recruitment, 2+ moderately decreased recruitment, and 1+ mildly decreased activity, associated with less than the full interference pattern. Coronal images were assessed in terms of differences in thickness and the vertical positions of the vocal folds.
  
  
  RESULTS
  Phonatory function improved significantly after operation in all patients. In terms of LEMG findings, the preoperative MU recruitment scores were 1+ in no patients, 2+ in 4 patients, 3+ in 1 patient, and 4+ in 7 patients. Postoperative MU recruitment results were 1+ in 6 patients, 2+ in 5 patients, 3+ in 1 patient, and 4+ in no patients. Thinning of the affected fold during phonation was evident preoperatively in 9 of 10 patients. The affected and healthy folds were equal in volume in 4 of 9 patients postoperatively.
  
  
  CONCLUSIONS
  The LEMG findings and coronal imaging suggest that NMP implantation may have enabled successful reinnervation of the laryngeal muscles of UVFP patients.
authors: Department of Otolaryngology-Head & Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto, Japan otostl0319@fc.kuh.kumamoto-u.ac.jp.
authors: Tetsuji
authors: T
authors: Sanuki
authors: Department of Otolaryngology-Head & Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto, Japan.
authors: Eiji
authors: E
authors: Yumoto
authors: Department of Otolaryngology-Head & Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto, Japan.
authors: Kohei
authors: K
authors: Nishimoto
authors: Department of Otolaryngology-Head & Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto, Japan.
authors: Narihiro
authors: N
authors: Kodama
authors: Department of Otolaryngology-Head & Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto, Japan.
authors: Haruka
authors: H
authors: Kodama
authors: Department of Otolaryngology-Head & Neck Surgery, Graduate School of Medicine, Kumamoto University, Kumamoto, Japan.
authors: Ryosei
authors: R
authors: Minoda
mesh_terms: D000328:Adult; D000368:Aged; D055154:Dysphonia / Q000601:surgery; D004576:Electromyography; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007821:Laryngeal Muscles / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D009469:Neuromuscular Junction; D010699:Phonation / Q000502:physiology; D012189:Retrospective Studies; D013524:Surgical Flaps; D014826:Vocal Cord Paralysis / Q000601:surgery*
keywords: coronal reconstructed image; laryngeal electromyography; laryngeal reinnervation; nerve-muscle pedicle implantation; unilateral vocal fold paralysis