{"doi":"10.1002/lary.30614","title":"What Is the Role of Laryngeal Reinnervation Surgery for Adults With Unilateral Vocal Fold Paralysis?","abstract":"Unilateral vocal fold paralysis (UVFP) is a common condition presenting to the otolaryngologist. Injury to the vagal nerve or recurrent laryngeal nerve (RLN) results in a flaccid vocal fold and breathy dysphonia. Current management of UVFP includes injection augmentation, type 1 medialization thyroplasty, arytenoid adduction, laryngeal reinnervation (LR), or LR with a combination of static procedures. The primary advantage of LR is prevention of denervation atrophy, which limits the long-term voice outcomes of static procedures. Recovery or maintenance of muscle tone from LR is expected to lead to more symmetric vibratory masses, symmetric mucosal wave propagation, and improved voice quality. However, the role of LR in management of adult UVFP remains controversial and is not fully established. Therefore, we evaluate the role of LR in the management of adults with UVFP. Aynehchi et al. performed a systematic review of LR techniques and identified that the most common LR technique was ansa cervicalis nerve to RLN anastomosis.1 Other reinnervation techniques described include direct implantation of an ansa cervicalis nerve branch or implantation of an ansa cervicalis neuromuscular pedicle (NMP) to the thyroarytenoid (TA) muscle. The least common LR technique is hypoglossal nerve to RLN anastomosis. LR surgery is often performed concurrently with static procedures, most commonly injection augmentation laryngoplasty. As such, current studies evaluating outcomes of LR are confounded by use of static medialization procedures. Thus, it may be unclear if the observed improvements are due to LR's effects on muscle tone and bulk or from phonatory posture due to medialization procedures. Pre-operative Laryngeal Electromyography (LEMG) has been used by some authors to evaluate residual laryngeal innervation and proceed with LR in the presence of denervation (fibrillation potentials or positive sharp waves). Maronian et al. performed LR using either ansa-RLN anastomosis or ansa-NMP implantation in patients with preoperative LEMG showing fibrillation potentials.2 Postoperatively, activation with head-lift was present in all patients and many also demonstrated motor unit action potentials and polyphasic potentials at rest, suggesting reinnervation. Paniello et al. compared pre- and post-operative LEMG in patients who underwent LR with ansa-RLN anastomosis.3 Nearly all patients with absent recruitment and fibrillation potentials (graded as worse degree of denervation) demonstrated a return of nascent or giant polyphasic potentials. All but one with residual innervation maintained their grade of innervation, thus demonstrating reinnervation after LR in all patients. These results suggest that LR is most beneficial in patients with dense denervation based on LEMG criteria, but patients with some residual laryngeal innervation also reinnervate well using the donor nerve. Li et al. reported the effects of duration of denervation on outcomes after LR with ansa-RLN anastomosis.4 Three hundred forty-nine adults were classified based on duration of denervation: 6–12 months, 12–24 months, and >24 months. Regardless of duration of injury, all patients had significantly improved glottic closure, acoustic outcome measures (jitter, shimmer, noise-to-harmonics ratio [NHR], mean phonation time [MPT]), and voluntary motor unit recruitment on LEMG. However, acoustic outcomes, maximum phonation time, and voluntary motor unit recruitment were significantly improved in those with denervation of <24 months compared to >24 months. Although there have been few reports of LR performed on patients after 20–40 years of denervation, this large study suggests that reinnervation within 2 years of insult can improve the degree of clinical and LEMG outcomes. Some authors consider patient age to determine candidacy for LR, as older age has been shown to have a detrimental impact on neuro-regeneration. Li et al. studied age-related outcomes after ansa-RLN anastomosis in four","journal":"The Laryngoscope","year":2023,"id":376500,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9588,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1139735,"name":"Kirsten Meenan","orcid":"0000-0001-6353-3232","position":1,"is_corresponding":false},{"id":418719,"name":"Dinesh K. Chhetri","orcid":"0000-0003-0228-6308","position":2,"is_corresponding":false},{"id":966049,"name":"Pranati Pillutla","orcid":"0000-0001-5765-2761","position":0,"is_corresponding":true}],"reference_count":5,"raw_metadata":null,"created_at":"2026-07-19T01:16:32.368674Z","pmid":"36757023","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}