LONG-TERM FOLLOW-UP OF RECURRENT LARYNGEAL NERVE AVULSION FOR THE TREATMENT OF SPASTIC DYSPHONIA

Long-term follow-up of 3 to 7 years is reported on 18 patients who had undergone recurrent laryngeal nerve avulsion (RLNA) for the treatment of adductor spastic dysphonia (SD). Data on neural regrowth after pre vious recurrent laryngeal nerve section (RLNS) are presented in 2 of t hese 18 patients. We introduced RLNA as a modification of standard RLN S to prevent neural regrowth to the hemiparalyzed larynx and subsequen t recurrence of SD. We have treated a total of 22 patients with RLNA, and now report a 3- to 7-year follow-up on 18 of these 22 patients. Re solution of symptoms was determined by routine follow-up assessment, p erceptual voice analysis, and patient self-assessment. Sixteen of 18, or 89%, had no recurrence of spasms at 3 years after RLNA as determine d at routine followup. Two of the 16 later developed spasms after medi alization laryngoplasty for treatment of weak voice persistent after t he avulsion. This yielded a total of 14 of 18, or 78%, who were unanim ously judged by four speech pathologists to have no recurrence of SD a t the longer follow-up period of 3 to 7 years. Two of these 4 patients were judged by all four analysts to have frequent, short spasms. The other 2 were judged by two of four analysts to have seldom, short spas ms. Three of 18 patients presented with recurrent SD after previous RL NS. At the time of subsequent RLNA, each patient had evidence of neura l regrowth at the distal nerve stump as demonstrated by intraoperative electromyography and histologic evaluation of the distal nerve stump. One remained free of SD following RLNA, 1 was free of spasms at 4 yea rs after revision avulsion but developed spasms after medialization la ryngoplasty, and the final patient developed spasms 3.75 years after r evision RLNA. Medialization laryngoplasty with Silastic silicone rubbe r was performed in 6 of 18, with correction of postoperative breathine ss in all 6, but with recurrence of spasm in 3. Spasms resolved in 1 o f these with downsizing of the implant. We conclude that RLNA represen ts a useful treatment in the management of SD in patients not tolerant of botulinum toxin injections.