Donghui Chen, MD, and Shicai Chen, MD, contributed equally to this work.
Spontaneous regeneration of recurrent laryngeal nerve following long-term vocal fold paralysis in humans: Histologic evidence†
Article first published online: 25 APR 2011
Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 121, Issue 5, pages 1035–1039, May 2011
How to Cite
Chen, D., Chen, S., Wang, W., Zhang, C. and Zheng, H. (2011), Spontaneous regeneration of recurrent laryngeal nerve following long-term vocal fold paralysis in humans: Histologic evidence. The Laryngoscope, 121: 1035–1039. doi: 10.1002/lary.21739
This work was supported by Grants No. 30772415, 81070774, and 81070775 for science research from the National Natural Science Foundation of China and Grants No. 09JC1400500 and 10XD1405500 from the Science and Technology Commission of Shanghai Municipality. The authors have no other funding, financial relationships, or conflicts of interest to disclose.
- Issue published online: 25 APR 2011
- Article first published online: 25 APR 2011
- Manuscript Accepted: 11 JAN 2011
- Manuscript Revised: 7 JAN 2011
- Manuscript Received: 5 OCT 2010
- Recurrent laryngeal nerve;
- vocal fold paralysis;
- subclinical reinnervation;
- Level of Evidence: 2
To validate the occurrence of spontaneous regeneration of the recurrent laryngeal nerve (RLN) in patients with symptomatic vocal fold paralysis (VFP).
Between June 2008 and February 2009, 29 patients with symptomatic unilateral VFP caused by thyroid surgery were continuously enrolled in this study, with 30 normal RLNs serving as the control. The denervation course was from 7 to 74 months. Intraoperative exploration was performed to identify the sites and types of RLN lesions. The status of RLN regeneration was detected by histologic examination, and the number of myelinated axons was counted.
Intraoperative exploration showed that RLN was transected in 24 cases, and the continuity of the RLN stump was recognized in the five other cases. Connective tissue connected the distal and the proximal ends of all transected RLNs under a surgical microscope. Light microscopy showed varying numbers (17–259) of abnormal myelinated axons in these injured RLNs; the maximum was less than 40% of those of normal RLNs (658 ± 79). Electron microscopy also demonstrated that abnormal myelinated axons with small diameters commonly existed in all injured RLNs, with dark myelin clumps without axons (Bungner bands) and fibrotic components.
The present study demonstrates that a varying degree of spontaneous RLN regeneration is substantially engaged in the process of subclinical reinnervation following laryngeal denervation in humans, which may account for different clinical characteristics and outcomes of VFP.