Bilateral motion restored to the paralyzed canine larynx with implantable stimulator
| Autor: | Yash A. Choksi, Yasuaki Harabuchi, Akihiro Katada, Shan Huang, Cheryl R. Billante, Kenichiro Nomura, Rajshri Mainthia, Charles T. Wright, David L. Zealear, Isamu Kunibe |
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| Rok vydání: | 2010 |
| Předmět: |
Larynx
Electric Stimulation Therapy Stimulation Vocal Cords Dogs medicine Paralysis Animals Prospective Studies Treadmill Denervation Recurrent Laryngeal Nerve business.industry Recovery of Function medicine.disease Deglutition Electrodes Implanted Disease Models Animal Treatment Outcome medicine.anatomical_structure Otorhinolaryngology Laryngeal paralysis Anesthesia Laryngeal Muscles medicine.symptom business Airway Vocal Cord Paralysis Follow-Up Studies Muscle Contraction Reinnervation |
| Zdroj: | The Laryngoscope. 120:2399-2409 |
| ISSN: | 0023-852X |
| Popis: | Objectives/Hypothesis: Bilateral stimulation ofposterior cricoarytenoid (PCA) muscles offers a physi-ologic approach to restore ventilation to a normallevel in case of bilateral laryngeal paralysis. Theobjective of this study was to evaluate the long-termefficacy and safety of a new generation stimulator inrestoring ventilation and exercise tolerance.Study Design: A prospective study of four can-ines over 8–20 months.Methods: A Genesis XP stimulator and electro-des were implanted and recurrent laryngeal nerveswere sectioned and repaired bilaterally. In bimonthlysessions, vocal fold movement resulted from PCAstimulation or induced hypercapnea, was measuredendoscopically in the anesthetized animal. Exercisetolerance was measured on a treadmill and swallow-ing function was examined endoscopically andradiographically.Results: During the denervation phase, therewas minimal ventilatory compromise and near-nor-mal exercise tolerance. PCA stimulation producedonly nominal abduction. During the reinnervationphase, synkinetic reinnervation became significant,resulting in a narrowed passive airway and paradoxi-cal glottic closure during hypercapnea. Animals werestridorous and could walk for only 1–2 minutes. Bilat-eral PCA stimulation increased glottal area, equalingthat of a normally innervated animal. Exercise toler-ance was also normal. The optimal stimulus para-digm for the synkinetically reinnervated larynx wasnot different from that for the innervated larynx.Stimulation remained efficacious over the study pe-riod. Lead integrity could be maintained by preven-tion of device migration. There was no evidence ofaspiration.Conclusions: This study demonstrates that ven-tilatory compromise only occurs following faulty rein-nervation. Bilateral PCA stimulation can restore ven-tilation and exercise tolerance completely withoutaspiration over the long term.Key Words: Canine, laryngeal pacing, bilateralvocal fold paralysis, electrical stimulation, posterior,cricoarytenoid, muscle, ventilation, aspiration.Level of Evidence:1CLaryngoscope, 120:2399–2409, 2010 |
| Databáze: | OpenAIRE |
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