Reinnervation of the Recurrent Laryngeal Nerve with the

1
Reinnervation of the Recurrent Laryngeal Nerve
with the Ansa Cervicalis A Case Study Lauren
Adragna Leah Skladany, Ph.D.
Voicing
Fully Adducted
Fully Abducted
7-05
7-05
7-05

• Post-Thymectomy Sponatneous Recovery of (R)TVF
• 9/05 Greater abduction of (R)TVF.
• 1/06 Greater abduction and adduction of (R)TVF.
• 5/06 80-90 abduction 100 adduction.
• 1/07 Normal (R)TVF mobility.
• Post-Reinnervation Recovery of (L)TVF
• 1/07 Normal bulk and tone in (L)TVF. Vibration
  was periodic with some amplitude and phase
  variability. Normal vibration at habitual pitch.
  Slight posterior glottic chink.

• Demographic Information
• Client M.B.
• Age 44 years old
• Gender Female
• Ethnicity Caucasian

9-05
9-05
9-05

• Medical History
• Myasthenia Gravis (MG).

• History of Reinnervation of the Recurrent
  Laryngeal Nerve with the Ansa Cervicalis
• Reinnervation of the Recurrent Laryngeal Nerve
  with the Ansa Cervicalis. The Ansa Cervicalis
  nerve is re-routed from its normal position in
  the neck to the larynx.
• Indications
• Therapy for unilateral vocal fold paralysis if
  the arytenoid cartilage is mobile and the ansa
  cervicalis has not been disrupted.
• Contraindications
• Can not be performed if the patient has any
  fixation of the arytenoid cartilages, or if the
  ansa cervicalis has been disrupted.
• Outcomes
• Provides muscle tone to the thyroarytenoid
  muscle, thereby, promoting normal vibration.
• Maintains bulk of the paralyzed vocal fold.
• Prevents vocal fold atrophy.

• Surgical History
• Thymectomy (Full Sternotomy) May 2005. TX for MG
• (L)TVF reinnervated with the Ansa Cervicalis in
  September 2006.
• Surgical Complications
• In the recovery room following thymectomy,
  patient was emergently intubated.
• Bilateral vocal fold paralysis was diagnosed.
• Patient refused tracheotomy.

1-06
1-06
1-06
5-06
5-06
5-06

• Thymectomy
• Thymectomy removal of thymus gland.
• May be used to treat MG.
• The thymus gland secretes antibodies against
  neuromuscular junction.
• Sternal Approach Thymectomy (Full Sternotomy)
  incision is made midline chest through the
  sternum in order to expose the thymus gland.
• Most invasive technique that allows for maximum
  visualization.
• Partial Sternotomy small incision made down
  middle of chest through half of sternum.
• Cosmetic approach and a shorter recuperating
  time.
• Thoracoscopic Thymectomy two to three incisions
  made on the side of chest.
• Cosmetic approach.
• Transcervical Thymectomy small horizontal
  incision made at lower part of neck.
• Least post operative pain and recovery period.
• Risks of a thymectomy from a sternal approach
  include sternal bleeding, collapsed lung,
  post-operative infection, sternal disruption,
  tracheal stenosis, pneumonia, heart failure,
  gastric hemorrhage, and respiratory
  insufficiency.

1-07
1-07
1-07

• Bibliography
• Kaminski, Henry J. M.D. (2003). Myasthenia
  gravis. Retrieved April 9, 2007, from
  http//www.netwellness.org/healthtopics/gravis/box
  5.cfm.
• Kas, Jozsef, Kiss, Dorottya, Major, Laszlo,
  Simon, Veronika, Svastics, Egon, Szobor, Albert
  (2001) Decade-long experience with surgical
  therapy of myasthenia gravis early complications
  of 324 transsternal thymectomies. The Annals of
  Thoracic Surgery, 72 (5), 1691-1697. Abstract
  retrieved April 17, 2007, from CAT.INIST
  database.
• Pou, Anna M., M.D., Quinn, Francis B., M.D.
  Reddy, Shashidhar S., M.D., MPH, Ryan, Matthew
  W., M.D. (2004, April 28). Vocal cord paralysis
  and vocal cord medialization
• University of Maryland Medical Center, Myasthenia
  Gravis Center, (2004). Surgical treatment
  options. Retrieved April 17, 2007, from
  http//www.umm.edu/mg/surgery.html.

4-07
4-07
4-07