Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, USA.
Laryngoscope. 2010 Dec;120(12):2399-409. doi: 10.1002/lary.21065.
OBJECTIVES/HYPOTHESIS: Bilateral stimulation of posterior cricoarytenoid (PCA) muscles offers a physiologic approach to restore ventilation to a normal level in case of bilateral laryngeal paralysis. The objective of this study was to evaluate the long-term efficacy and safety of a new generation stimulator in restoring ventilation and exercise tolerance.
A prospective study of four canines over 8-20 months.
A Genesis XP stimulator and electrodes were implanted and recurrent laryngeal nerves were sectioned and repaired bilaterally. In bimonthly sessions, vocal fold movement resulted from PCA stimulation or induced hypercapnea, was measured endoscopically in the anesthetized animal. Exercise tolerance was measured on a treadmill and swallowing function was examined endoscopically and radiographically.
During the denervation phase, there was minimal ventilatory compromise and near-normal exercise tolerance. PCA stimulation produced only nominal abduction. During the reinnervation phase, synkinetic reinnervation became significant, resulting in a narrowed passive airway and paradoxical glottic closure during hypercapnea. Animals were stridorous and could walk for only 1-2 minutes. Bilateral PCA stimulation increased glottal area, equaling that of a normally innervated animal. Exercise tolerance was also normal. The optimal stimulus paradigm for the synkinetically reinnervated larynx was not different from that for the innervated larynx. Stimulation remained efficacious over the study period. Lead integrity could be maintained by prevention of device migration. There was no evidence of aspiration.
This study demonstrates that ventilatory compromise only occurs following faulty reinnervation. Bilateral PCA stimulation can restore ventilation and exercise tolerance completely without aspiration over the long term.
目的/假设：双侧甲状旁腺后肌（PCA）肌肉刺激提供了一种生理方法，以在双侧喉麻痹的情况下将通气恢复到正常水平。本研究的目的是评估新一代刺激器恢复通气和运动耐量的长期疗效和安全性。
对 4 只犬进行了 8-20 个月的前瞻性研究。
植入 Genesis XP 刺激器和电极，并双侧切断和修复喉返神经。在每两个月一次的会议中，在麻醉动物中通过内窥镜测量 PCA 刺激或诱导的高碳酸血症引起的声带运动。在跑步机上测量运动耐量，通过内窥镜和放射学检查吞咽功能。
在去神经支配阶段，通气仅受到轻微影响，运动耐量接近正常。PCA 刺激仅产生名义上的外展。在再神经支配阶段，协同再神经支配变得显著，导致被动气道变窄，高碳酸血症时声门关闭出现反常。动物出现喘鸣，只能行走 1-2 分钟。双侧 PCA 刺激增加了声门区域，与正常神经支配的动物相等。运动耐量也正常。对于协同再神经支配的声带，最佳刺激范式与神经支配的声带不同。刺激在研究期间仍然有效。通过防止器械迁移，可以维持导联的完整性。没有吸入的证据。
本研究表明，通气受限仅发生在错误再神经支配之后。双侧 PCA 刺激可以长期完全恢复通气和运动耐量，而不会出现吸入。
