While any motor nerve can be cut and anastamosed (hooked up) to another nerve and over time this new nerve will grow into the muscles of the old nerve, the main reinnervation surgery that I perform for the voice, is to supply new neural input to the adductor muscles of the larynx. I typically use the omohyoid branch of the Ansa cervicalis as the donor nerve and hook this up to the anterior branch of the recurrent laryngeal nerve. This can provide new and appropriate input to the muscle within the vocal cord (thyroarytenoid muscle or vocalis muscle). it can also supply the lateral cricoarytenoid muscle which is the muscle that closes the vocal cords together.
There are variations on this technique, including hooking a donor nerve up to the main branch of the recurrent laryngeal nerve. There are also people working to find an appropriate donor nerve for the opening muscles of the larynx.
- The risk of anesthesia is that you could have a major life threatening reaction to some medication. This is very uncommon and I would compare it to getting in your car and driving some distance with the risk of an accident and dying. Even though the risk is severe, it is acceptably small, as most of us continue to drive. In the case of surgery, you even have the added benefit of life support equipment and trained personnel standing by. This procedure is performed under general anesthesia and the operation may last about 2 hours.
Less-than-expected beneficial outcome
- If the nerve does not grow in, the individual may be left with a soft and weak voice.
- Bleeding is a potential risk anytime a cut is made. This is primarily a problem after the surgery, where, if a blood vessel breaks, a hematoma may form under the skin that could require another surgical procedure to drain it out. If you are on any medication that may thin the blood, that would increase the risk. Examples of medications that might prolong bleeding include Coumadin, aspirin or even vitamin E. You should go over all medications that you take with your physician before surgery. A drain may be left in the wound for blood or fluid to come out. It would typically be removed in one to three days.
- Any time a skin incision is made, that becomes a route for bacteria to enter into the body. This procedure is performed under sterile conditions and an antibiotic may be given in the operating room.
The operating room
It is likely that you will have a vey weak voice. It is also likely that you will have initial difficulty swallowing liquids without choking on them. Drinking through a straw or with your head tucked to your chin may help alleviate some of the choking. Thickening of drinking liquids may also help.
The incision should be kept dry for at least 24 hours after surgery. This allows enough time for the skin edges to seal over. I typically place cyanoacrylate glue over the incision which allows it to get wet fairly early after the surgery.
Speaking will also be a bit of work. When the vocal cords don’t occlude tightly (and they won’t after surgery for a while) it takes a lot of air to set them vibrating. This leads to several symptoms. Most people say they are “short of breath”. You will actually be running a lot of air in and out of the lungs. You may feel dizzy or lightheaded from what amounts to hyperventilation. Talking and walking at the same time could be difficult. Additionally, the voice as it recovers may sound a bit high or squeaky. The muscles that create high pitch (cricothyroid) try to kick in and bring the weakened vocal cords together.
Scars go through a maturation process that takes about a year. During the first half of that time, the scar will tend to be pink and will tend to pigment very easily if exposed to the sun. That will make the scar more visible. I recommend using SPF 40 sunscreen to prevent this pigmentation. I have no opinion on the use of vitamin E on the incision. It certainly does no harm, though I do not know that it helps. Since the voice box elevates when swallowing, the scar can tether to the deeper tissues and move conspicuosly during swallowing. This may correct with time or be corrected later after healing finishes.
- It is likely that you will have a vey weak voice. It is also likely that you will have initial difficulty swallowing liquids without choking on them. Drinking through a straw or with your head tucked to your chin may help alleviate some of the choking. Thickening of drinking liquids may also help.
- Return for a follow up visit to see how you have healed. Feel free to use your voice as much as you can tolerate.
- Mid-term evaluation, if possible
- If you are in the area, I would like to see you
- Long-term evaluation of your surgery.