This article was presented at the American Laryngological Association Meeting in Orlando, Florida, U.S.A., on April 10, 2013.
Stimulation of denervated muscle promotes selective reinnervation, prevents synkinesis, and restores function
Version of Record online: 19 NOV 2013
© 2013 The American Laryngological, Rhinological and Otological Society, Inc.
Volume 124, Issue 5, pages E180–E187, May 2014
How to Cite
Zealear, D. L., Mainthia, R., Li, Y., Kunibe, I., Katada, A., Billante, C. and Nomura, K. (2014), Stimulation of denervated muscle promotes selective reinnervation, prevents synkinesis, and restores function. The Laryngoscope, 124: E180–E187. doi: 10.1002/lary.24454
This research was supported by National Institutes of Health (NIH) Grants R01-DC001149 and R01-DC008429. The authors have no other funding, financial relationships, or conflicts of interest to disclose.
- Issue online: 18 APR 2014
- Version of Record online: 19 NOV 2013
- Accepted manuscript online: 6 OCT 2013 06:49AM EST
- Manuscript Accepted: 23 SEP 2013
- Manuscript Revised: 21 AUG 2013
- Manuscript Received: 9 APR 2013
- motor units;
Previously, electrical stimulation of denervated canine laryngeal muscle was shown to promote reinnervation by native over foreign motoneurons. The goal of this study was to assess the effect of different stimulus paradigms on reinnervation quality and functional recovery.
A prospective study of six canines over 8 to 20 months.
A clinical model of laryngeal paralysis was used, where recurrent laryngeal nerves of the animals were sectioned and ventilation compromised. The abductor, posterior cricoarytenoid (PCA) muscles were implanted bilaterally with electrodes from an implantable pulse generator. Animals were randomly assigned to three groups to assess the effect of different stimulus paradigms: 1) 40 pulses per second (pps) train, 2) 10 pps train, 3) no stimulation. Spontaneous vocal fold movement was measured endoscopically during hypercapnia. Exercise tolerance was measured on a treadmill using pulse oximetry. In the terminal session, electromyography (EMG) potentials were recorded during superior laryngeal nerve stimulation to index foreign reinnervation of the PCA by reflex glottic closure (RGC) motoneurons.
After reinnervation started, nonstimulated and stimulated 40 pps animals displayed paradoxical closure of the glottis during hypercapnia and severely decreased exercise tolerance due to faulty reinnervation. In contrast, stimulated 10 pps animals displayed minimal paradoxical closure and normal exercise tolerance (12 minutes up to 8 mph). EMG findings in this group demonstrated significantly less PCA reinnervation by foreign RGC motoneurons.
PCA stimulation with low frequency reduced synkinetic reinnervation by foreign RGC motoneurons. Paradoxical closure of the glottis with inspiration was reduced and exercise tolerance restored to normal.
Level of Evidence
N/A. Laryngoscope, 124:E180–E187, 2014