neuromuscular pedicle transplantation

Recurrent laryngeal nerve palsy can cause obstacles to the vocal, respiratory, and swallowing functions of the larynx. The use of thyroid cartilage surgery and sacral cartilage surgery for vocal cord paralysis is achieved by reducing or opening the glottis to improve vocalization or eliminate breathing disorders, but the improvement of vocalization and respiration is often contradictory, ie two The person can't have both, the louder the glottis is, the better the degree of breathing improvement, but the more it hurts the sound. For example, nerve anastomosis or neuromuscular pedicle transplantation can restore the normal physiological function of the larynx, which means that it can both repel the laryngeal adduction function and restore the laryngeal abduction function. It is the most ideal method for treating vocal cord paralysis. . Neuromuscular grafting is a new technology developed since the 1970s. Ogura, Sato, and others first studied, and Tucker promoted it to the clinic. It is a kind of surgery that has been used to treat bilateral recurrent laryngeal nerve palsy in an attempt to restore the function of the posterior iliac crest muscle. The Department of Otorhinolaryngology, Changhai Hospital of the Second Military Medical University headed by Professor Li Zhaoji has conducted a large number of animal experiments since 1986 and explored successful surgical methods. The advantages of neuromuscular pedicle transplantation are: 1 can completely preserve the motor endplate, without cutting and anastomosing the nerve, avoiding the degeneration of the nerve and the formation of neuroma, and does not produce the misalignment of the regenerated nerve fibers; 2 neuromuscular The pedicle and the implanted muscle bed heal quickly, the nerve fibers do not slip off the muscle bed, and the function recovers quickly; 3 is selectively transplanted into the affected larynx muscles, thereby avoiding adduction and abduction fiber staggering and dysfunction; 4 Restore the normal ventilation function of the airway without damaging the vocal function; 5 does not hinder the spontaneous recovery of the recurrent laryngeal nerve. However, some scholars believe that the effect of this operation is not good. It is proposed that the neuromuscular pedicle is transplanted to the posterior nucleus of the posterior iliac muscle. The slight abduction of the vocal cord after the pedicle is not the nerve in the pedicle. As a result, fibrosis and scar formation occur in the posterior iliac crest muscle, and the chord cartilage is pulled to abduct the vocal cords. Due to these controversies, neuromuscular grafting has not been widely used at home and abroad. Treating diseases: vocal cord polyps Indication Neuromuscular graft surgery is suitable for: 1. Bilateral vocal cord paralysis causes difficulty breathing or affects daily life and workers. 2. Patients with bilateral recurrent laryngeal nerve palsy may have sudden difficulty in breathing. Neuromuscular grafting is an operation that is most commonly used in clinical trials to restore the function of the posterior iliac crest. The advantages of neuromuscular pedicle transplantation are: 1 can completely preserve the motor endplate, do not cut and anastomosis, avoid neurodegeneration and neuroma formation, and will not produce the misalignment of regenerative nerve fibers; 2 neuromuscular pedicle The healing of the muscle bed with the implant is rapid, the nerve fibers do not slip off the muscle bed, and the function recovers quickly; 3 is selectively transplanted into the affected laryngeal muscles, thereby avoiding the adduction and abduction fiber interlacing and dysfunction; 4 recovery The normal ventilation function of the airway does not damage the vocal function; 5 does not hinder the possibility of automatic recovery of the recurrent laryngeal nerve. However, some scholars have observed that the effect is not good through animal experiments and clinical application observations. It is proposed that the neuromuscular pedicle is transplanted to the posterior nucleus of the posterior iliac muscle. The slight abduction of the vocal cords is not the result of the nerves in the pedicles extending into the posterior iliac crest muscles, but the fibrosis of the posterior tibial muscles. Scar formation, pulling the sacral cartilage causes the vocal cords to abduct. Due to these controversies, neuromuscular grafting has not been widely used at home and abroad. Contraindications 1. Both sides of the vocal cords with cartilage fixation. 2. The sublingual nerve palsy to the anterior cervical band muscle has been damaged. 3. Other airway lesions that cannot be corrected, even if the nerve is re-dominated successfully, the tracheal cannula cannot be removed. 4. The patient cannot bear the operator, such as severe craniocerebral trauma. Surgical procedure Tracheotomy 2. Position and incision Take the supine position and the head is biased to the opposite side. The skin of the neck is routinely disinfected, and the head is covered with a sterile towel. The lower edge of the flat thyroid cartilage, from the midline along the dermis to the anterior border of the sternocleidomastoid for incision, incision of the skin, subcutaneous tissue and platysma. 3. Preparation of neuromuscular pedicle Free the anterior border of the sternocleidomastoid muscle and pull it backward, find the sublingual nerve sac to the branch of the scapular humerus muscle, and separate down the branch to the nerve to actually enter the muscle, and cut the muscle block of 2~3mm3, together with the nerve Protect spare. 4. Exposing the posterior iliac muscle The posterior margin of the thyroid cartilage wing was pulled up with a small hook to expose the oblique fibers of the inferior pharyngeal muscle. The pharyngeal muscle fibers are bluntly separated near the thyroid cartilage. Do not cut the muscle fibers to expose the folds of the piriform fossa. The piriform fossa mucosa is separated upward to expose the posterior iliac crest muscle. The muscle fibers of the posterior iliac crest muscles are perpendicular to the muscle fibers of the inferior pharyngeal muscles. This feature helps to determine the posterior iliac muscle. 5. Fix the neuromuscular pedicle to the posterior iliac muscle The prepared neuromuscular pedicle was placed on the abdomen surface of the muscle of the posterior iliac crest, and fixed by 2 to 3 needles with a 5-0 nylon thread. More use of double muscle pedicle method. 6. Throat reduction, closing the incision layer by layer. Drain the wound.