Stimulation of denervated muscle promotes selective reinnervation, prevents synkinesis, and restores function. 2014

David L Zealear, and Rajshri Mainthia, and Yike Li, and Isamu Kunibe, and Akihiro Katada, and Cheryl Billante, and Kenichiro Nomura
Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, U.S.A.

OBJECTIVE 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. METHODS A prospective study of six canines over 8 to 20 months. METHODS 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. RESULTS 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. CONCLUSIONS 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.

UI MeSH Term Description Entries
D007821 Laryngeal Muscles The striated muscle groups which move the LARYNX as a whole or its parts, such as altering tension of the VOCAL CORDS, or size of the slit (RIMA GLOTTIDIS). Cricothyroid Muscles,Aryepiglottic Muscle,Arytenoid Muscle,Cricoarytenoid Muscles,Thyroarytenoid Muscles,Thyroepiglottic Muscle,Vocal Muscle,Vocalis Muscle,Aryepiglottic Muscles,Arytenoid Muscles,Cricoarytenoid Muscle,Cricothyroid Muscle,Laryngeal Muscle,Muscle, Aryepiglottic,Muscle, Arytenoid,Muscle, Cricoarytenoid,Muscle, Cricothyroid,Muscle, Laryngeal,Muscle, Thyroarytenoid,Muscle, Thyroepiglottic,Muscle, Vocal,Muscle, Vocalis,Muscles, Aryepiglottic,Muscles, Arytenoid,Muscles, Cricoarytenoid,Muscles, Cricothyroid,Muscles, Laryngeal,Muscles, Thyroarytenoid,Muscles, Thyroepiglottic,Muscles, Vocal,Muscles, Vocalis,Thyroarytenoid Muscle,Thyroepiglottic Muscles,Vocal Muscles,Vocalis Muscles
D007828 Laryngoscopy Examination, therapy or surgery of the interior of the larynx performed with a specially designed endoscope. Laryngoscopic Surgical Procedures,Surgical Procedures, Laryngoscopic,Laryngoscopic Surgery,Surgery, Laryngoscopic,Laryngoscopic Surgeries,Laryngoscopic Surgical Procedure,Laryngoscopies,Procedure, Laryngoscopic Surgical,Procedures, Laryngoscopic Surgical,Surgeries, Laryngoscopic,Surgical Procedure, Laryngoscopic
D009121 Muscle Denervation The resection or removal of the innervation of a muscle or muscle tissue. Denervation, Muscle,Denervations, Muscle,Muscle Denervations
D009416 Nerve Regeneration Renewal or physiological repair of damaged nerve tissue. Nerve Tissue Regeneration,Nervous Tissue Regeneration,Neural Tissue Regeneration,Nerve Tissue Regenerations,Nervous Tissue Regenerations,Neural Tissue Regenerations,Regeneration, Nerve,Regeneration, Nerve Tissue,Regeneration, Nervous Tissue,Regeneration, Neural Tissue,Tissue Regeneration, Nerve,Tissue Regeneration, Nervous,Tissue Regeneration, Neural
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D011897 Random Allocation A process involving chance used in therapeutic trials or other research endeavor for allocating experimental subjects, human or animal, between treatment and control groups, or among treatment groups. It may also apply to experiments on inanimate objects. Randomization,Allocation, Random
D012009 Recurrent Laryngeal Nerve Branches of the vagus (tenth cranial) nerve. The recurrent laryngeal nerves originate more caudally than the superior laryngeal nerves and follow different paths on the right and left sides. They carry efferents to all muscles of the larynx except the cricothyroid and carry sensory and autonomic fibers to the laryngeal, pharyngeal, tracheal, and cardiac regions. Laryngeal Nerve, Inferior,Inferior Laryngeal Nerve,Inferior Laryngeal Nerves,Laryngeal Nerve, Recurrent,Laryngeal Nerves, Inferior,Laryngeal Nerves, Recurrent,Nerve, Inferior Laryngeal,Nerve, Recurrent Laryngeal,Nerves, Inferior Laryngeal,Nerves, Recurrent Laryngeal,Recurrent Laryngeal Nerves
D002245 Carbon Dioxide A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. Carbonic Anhydride,Anhydride, Carbonic,Dioxide, Carbon
D004195 Disease Models, Animal Naturally-occurring or experimentally-induced animal diseases with pathological processes analogous to human diseases. Animal Disease Model,Animal Disease Models,Disease Model, Animal
D004285 Dogs The domestic dog, Canis familiaris, comprising about 400 breeds, of the carnivore family CANIDAE. They are worldwide in distribution and live in association with people. (Walker's Mammals of the World, 5th ed, p1065) Canis familiaris,Dog

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