Tixier C, Reyt E, Mezin P, Benchetrit G, Salazar O, Abdallah J, N'Guyen M, Junien-Lavillauroy C
Clinique ORL, CHU de Grenoble.
Ann Otolaryngol Chir Cervicofac. 1992;109(1):23-31.
This work has been carried out to investigate in an animal model, the possibility of surgical selective reinnervation of the larynx following destruction of the laryngeal branch of the vagus nerve.
In ten dogs, on the right side of the neck only, the recurrent laryngeal nerve was identified, cut and section of the nerve removed. Following this the hemi-larynx on the operated side was reinnervated in the following manner. Using a microsurgical suture (described in the text) the motor nerves from extra-laryngeal muscles were anastomosed onto the nerves supplying the intrinsic abductors and adductors of the larynx. The nerve to sterno-thyroid was anastomosed onto the nerve supplying the posterior crico-arytenoid muscle (vocal cord abductor). Similarly the nerve supplying thyrohyoid was anastomosed onto the cut distal end of the adductor division of the recurrent laryngeal nerve. Clinical, electromyographical and histological evaluations have been used to prove the reinnervation.
In the nine surviving animals successful re-innervations, as defined by the return of normal function, has been achieved for posterior crico-arytenoid and 7 adductor muscles.
This study has demonstrated the feasibility of laryngeal reinnervation after surgical section of the recurrent laryngeal nerve, and give some cause for optimism for its ultimate application in man.
本研究旨在通过动物模型，探讨迷走神经喉支被破坏后，喉进行手术选择性再支配的可能性。
选取10只犬，仅在右侧颈部识别并切断喉返神经，切除一段神经。之后，以如下方式对手术侧半喉进行再支配。使用显微外科缝线（文中有描述）将喉外肌的运动神经与支配喉内收肌和外展肌的神经进行吻合。将胸骨甲状肌神经与支配环杓后肌（声带外展肌）的神经进行吻合。同样，将甲状舌骨肌神经与喉返神经内收肌分支的切断远端进行吻合。通过临床、肌电图和组织学评估来证实再支配情况。
在9只存活的动物中，实现了环杓后肌和7块内收肌的成功再支配，即恢复了正常功能。
本研究证明了喉返神经手术切断后喉再支配的可行性，并为其最终应用于人类带来了一些乐观的理由。
