Modified first or second cervical nerve transplantation technique for the treatment of recurrent laryngeal neuropathy in horses.

Modified first or second cervical nerve transplantation technique for the treatment of recurrent laryngeal neuropathy in horses.

Equine Vet J. 2017 Nov 28;:

Authors: Rossignol F, Brandenberger O, Perkins JD, Marie JP, Mespoulhès-Rivière C, Ducharme NG

Abstract
BACKGROUND: In horses, the only established method for reinnervation of the larynx is the nerve-muscle pedicle implantation, whereas in human medicine, direct nerve implantation is a standard surgical technique for selective laryngeal reinnervation in patients suffering from bilateral vocal fold paralysis.
OBJECTIVES: (1) To describe a modified first or second cervical nerve transplantation technique for the treatment of recurrent laryngeal neuropathy (RLN) in horses and (2) evaluate the outcomes of reinnervation using direct nerve needle-stimulation of the first cervical nerve and exercising endoscopy before and after surgery.
STUDY DESIGN: Case series.
METHODS: Nerve transplantation surgery, in which the first or second cervical nerve is tunnelled through the atrophied left cricoarytenoideus dorsalis muscle, was performed in combination with ipsilateral laser ventriculocordectomy. Ultrasound-guided stimulation of the first cervical nerve at the level of the alar foramen was used to confirm successful reinnervation postoperatively. Exercising endoscopy was performed before and after surgery. The exercising RLN grade of the left arytenoid was blindly determined at the highest stride frequency for each examination.
RESULTS: Surgery was performed in 17 client-owned animals with RLN. Reinnervation was confirmed by nerve stimulation and subsequent arytenoid abduction observed in 11 out of 12 cases between 4 and 12 months post-operatively. Fourteen horses had exercising endoscopy before and after surgery. Nine horses had an improved exercising RLN grade, 4 horses had the same exercising grade and one horse had a worse exercising grade after surgery.
MAIN LIMITATIONS: A sham-operated control group was not included and follow-up beyond 12 months and objective performance data were not obtained.
CONCLUSIONS: The modified first or second cervical nerve transplantation technique, using tunnelling and direct implantation of the donor nerve into the crico-arytenoideus dorsalis muscle, resulted in reinnervation in 11/12 of cases and improved exercising grade in 9/14 horses within 12 months after surgery. This article is protected by copyright. All rights reserved.

PMID: 29193393 [PubMed - as supplied by publisher]

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