Recovery of Voice After Reconstruction of the Recurrent Laryngeal Nerve and Adjuvant Nimodipine.

BACKGROUND: Transection injury to the recurrent laryngeal nerve (RLN) has been associated with permanent vocal fold palsy, and treatment has been limited to voice therapy or local treatment of vocal folds. Microsurgical repair has been reported to induce a better function. The calcium channel antagonist nimodipine improves functional recovery after experimental nerve injury and also after cranial nerve injury in patients. This study aims to present voice outcome in patients who underwent repair of the RLN and received nimodipine during regeneration. METHODS: From 2002-2016, 19 patients were admitted to our center with complete unilateral injury to the RLN and underwent microsurgical repair of the RLN. After nerve repair, patients received nimodipine for 2-3 months. Laryngoscopy was performed repeatedly up to 14 months postoperatively. The Voice Handicap Index (VHI) was administered, and patients' maximum phonation time (MPT) was recorded during the follow-up. RESULTS: All patients recovered well after surgery, and nimodipine was well tolerated with no dropouts. None of the patients suffered from atrophy of the vocal fold, and some patients even showed a small ab/adduction of the vocal fold on the repaired side with laryngoscopy. During long-term follow-up (>3 years), VHI and MPT normalized, indicating a nearly complete recovery from unilateral RLN injury. CONCLUSIONS: In this cohort study, we report the results of the first 19 consecutive cases at our center subjected to reconstruction of the RLN and adjuvant nimodipine treatment. The outcome of the current strategy is encouraging and should be considered after iatrogenic RLN transection injuries.

Nimodipine and microsurgery induced recovery of the vocal cord after recurrent laryngeal nerve resection.

Transection of the recurrent laryngeal nerve leads to permanent palsy of the vocal cord. Experimental studies have confirmed that nimodipine increases the pace of axonal regeneration. We present a case of a 19-year-old male, suffering a thyroid cancer disease, who was subjected to unilateral resection of the recurrent laryngeal nerve during surgery. The nerve was repaired with a nerve graft and the patient further treated with nimodipine for 3 months. Evaluation of the patient showed normalization of voice, movement of the vocal cord on the injured side, and electromyography evidence of reinnervation of the larynx muscles at 15 months after surgery.

Vibratory capacity and voice outcome in patients with scarred vocal folds treated with collagen injections--case studies.

This prospective case study evaluates the effect of collagen injections on vibratory capacity and voice outcome in four patients with vocal fold scarring. The minimum follow-up time was 6 months. We studied the effect of the injections on the vibratory capacity in a multidimensional way, using computerized image analysis of videostroboscopy, acoustic and perceptual analysis of voice recordings, as well as patients' self-evaluations. Subjective voice ratings from the patients showed improvement in two patients, while two patients had no change in voice function. None of the patients experienced any side effects from the treatment. The documented acoustic and perceptual changes were marginal, but the videostroboscopic findings suggest some improvement in vibratory capacity.

Leakage around voice prosthesis in laryngectomees: treatment with local GM-CSF.

OBJECTIVES: The aim of this study was to investigate the possibility of treating leakage around voice prosthesis by local injection of granulocyte-macrophage colony-stimulating factor (GM-CSF). STUDY DESIGN: Three patients with nonhealing leaking tracheoesophageal (TE) fistula, resistant to common treatment, were treated with local GM-CSF. MATERIAL AND METHODS: Fistula size was measured and photo documented before and after treatment. RESULT: In all three patients, the fistula shrank, and the leakage ceased. No side effects were observed. CONCLUSION: Local injection with GM-CSF seems to be a simple and effective way of decreasing a leaking TE-fistula in laryngectomized patients. A great advantage was that the procedure could be done with the voice prosthesis in place.

[Fiberoptic endoscopy confirms the cause of upper respiratory obstruction in small children. The most common causes to referrals are sleep apnea syndrome and inspiratory stridor]. / Fiberskopi fastställer orsak till höga andningshinder hos små barn. Vanligaste remissorsakerna sömnapnésyndrom och inspiratorisk stridor.

Guidelines for the clinical investigation of young children with stridor and sleep apnea are presented. Clinical examination and flexible videolaryngoscopy performed in local anaesthesia are the most important diagnostic tools for this group of children. If the impairment is severe or an objective evaluation is needed the child should also undergo nocturnal polygraphic recording and lung function tests. Out of 43 children examined with flexible videolaryngoscopy 21 had positive findings, laryngomalacia being the most common diagnosis. Flexible videolaryngoscopy is a good complement to laryngoscopy under general anaesthesia. It can be performed as early as in the neonatal period.