[Surgery of the recurrent nerve. Studies on the problem of functional rehabilitation after recurrent nerve injuries]

Abstract

One of the most important problems involved in rehabilitation surgery of the recurrent nerve arises from the fact that this nerve carries fibers displaying antagonistic activities which is an accordance with the different functions of the larynx as an organ of phonation, respiration and swallowing. As a consequence of random reinnervation of the internal laryngeal musculature taking place after reconstruction of the N. recurrens, the complicated sequence of vocal cord movements, varying with the different functions of the larynx, cannot be restituted in its proper order. To avoid such functional failures, a method for selective reinnervation of the M. posticus as the most important glottis opener on the one hand, and of the glottis-closing musculature on the other, was tested in animal experiments. Two different anastomoses are forming the basis of the experimental model. 1. Phrenicus-ramus posterior anastomosis for reinnervation of the M. posticus. 2. Recurrens-ramus anterior anastomosis for reinnervation of the adductors. The results show that successful reinnervation of the abductor by means of the phrenic nerve, and of the adductors by means of the recurrence nerve separated from the vagus, can be achieved, and that this reinnervation also permits satisfactory phase-synchronous regulation.