Functional Outcomes Following Delayed Laryngeal Reinnervation Of Patients with Vagal Paralysis After Paraganglioma and Schwannoma Surgery

Estephania Candelo; Daniele Borsetto; Rupert Obholzer; Peter Clarke; Marina MatBaki; Martin Birchall

doi:10.1016/j.jvoice.2021.03.021

Functional Outcomes Following Delayed Laryngeal Reinnervation Of Patients with Vagal Paralysis After Paraganglioma and Schwannoma Surgery

J Voice. 2023 Jul;37(4):610-615. doi: 10.1016/j.jvoice.2021.03.021. Epub 2021 May 13.

Authors

Estephania Candelo¹, Daniele Borsetto², Rupert Obholzer², Peter Clarke³, Marina MatBaki⁴, Martin Birchall⁵

Affiliations

¹ Ear Institute, University College London and University College London Hospitals NHS Foundation Trust, London, UK; Head and Neck Department, Fundacion Valle del Lili, Cali Colombia. Electronic address: m.birchall@ucl.ac.uk.
² Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
³ Charing Cross Hospital, Imperial College Healthcare NHS Trust, London UK.
⁴ Faculty of Medicine, Universiti Kebangsaan Malaysia.
⁵ Ear Institute, University College London and University College London Hospitals NHS Foundation Trust, London, UK.

PMID: 33994255
DOI: 10.1016/j.jvoice.2021.03.021

Abstract

Purpose: We present a prospective case series that aimed to report the functional (voice and swallowing) outcomes of delayed laryngeal reinnervation following vagal interruption by resection of vagal paraganglioma and schwannoma.

Materials and methods: A dedicated, anonymized database was established in 2012 with a minimum eighteen-month follow up set for this report. Internationally validated self- and observer-reported measures were recorded preoperatively and at six, 12 and, 18 months together with demographics, diagnoses, and operative details.

Results: A total of eight patients with a median age of 46 (37-54) underwent excision of vagal paraganglioma (five) and schwannoma (three) with few mild complications. Three underwent selective and five non selective reinnervation. Seven out of eight patients underwent synchronous injection medialization. The voice handicap index (VHI-30) improved from a baseline median 83 (range 52-102) to 7.5 (5-58) at 18 months; maximum phonation time improved from median 8 (range 5-15) to 10.5 (8.5-11); voice grade ("G" in grade, roughness, breathiness, asthenia, and strain [GRBAS] scoring) improved from median three (severe impairment, range 0-3) to one (mild impairment, 0-2); Eating Assessment Tool (EAT-10) score improved from median 12 (range 3.5-27) preoperatively to one (0-16); and reflux symptom index (RSI) improved from median 25 (range 17-36) to 7 (0-36). One patient exhibited no discernible reinnervation, while the remainder exhibited good cord bulk and tone, though without purposive abduction.

Conclusion: Delayed laryngeal reinnervation for high vagal paralysis is a safe technique associated with good voice and swallowing outcomes by 12-18 months. Potential confounders in this small series and the absence of a control arm both limit conclusions, but this study suggests that further prospective, controlled studies, and/or case registration are merited.

Keywords: Vagal paraganglioma—Vocal cord paralysis—Laryngeal reinnervation—Laryngeal nerve injuries—Vagus nerve.

MeSH terms

Humans
Larynx* / surgery
Neurilemmoma* / complications
Neurilemmoma* / surgery
Paraganglioma* / complications
Paraganglioma* / diagnosis
Paraganglioma* / surgery
Recurrent Laryngeal Nerve / surgery
Treatment Outcome
Vocal Cord Paralysis* / diagnosis
Vocal Cord Paralysis* / etiology
Vocal Cord Paralysis* / surgery