Selective laryngeal adductor denervation-reinnervation: A new surgical treatment for adductor spasmodic dysphonia

During the past decade, botulinum toxin (Botox) has emerged as the accepted treatment for adductor spasmodic dysphonia (ASD). This therapy, which prod uces bilateral weakness of the thyroarytenoid muscle, undoubtedly produces physiologic effects that are beneficial to patients with ASD. However, it a lso has important limitations, including the need for repeated injections, the unpredictable relationship between dosage and response, and the possibi lity of short-term swallowing and voice problems. In this study, we will re port our preliminary experience with a new surgical treatment for ASD. In t his new procedure, the adductor branch of the recurrent laryngeal nerve is selectively denervated bilaterally, and its distal nerve stumps are reinner vated with branches of the ansa cervicalis nerve. Each of the patients was followed for at least 12 months; the median follow-up is 36 months. The out come of the operation in 21 consecutive patients is reported. Nineteen of t he 21 patients were judged to have an overall severity of dysphonia that wa s "absent to mild" following the procedure. Only 1 patient underwent furthe r treatment with Botox postoperatively. The implications of this new proced ure for ASD are discussed.