QUAD #19: Laryngeal Sensory Reinnervation with Dr. Charles Myer IV

Swallowing is not just a motor issue, it's also a sensory issue requiring combined focus on both components.

Laryngeal sensation is a vagal function that comes in through the ipsilateral internal branch of the superior laryngeal nerve.

Most children with recurrent laryngeal nerve injuries do not have high vagal injuries; the etiology is often iatrogenic from cardiac procedures or thyroid surgery.

FEES plus sensory testing uses a calibrated air pulse by a generator to stimulate the laryngeal adductor reflex for objective assessment of laryngeal sensation.

The laryngeal adductor reflex is an involuntary reflection that can be observed as a brief break in respiration or stimulation of a swallow or laryngeal squeeze on video.

A clinical examination technique involves using a 2.2 mm scope to touch various points around the larynx to elicit a cough, swallow, or response in the child.

Results of sensory reinnervation are expected to occur between 9 to 12 months post-operatively.

Sensory reinnervation should be considered for patients with sensory deficits, high degree of aspiration, and when at the end of other treatment options to improve swallowing or protect lungs.

Combined ansa to recurrent laryngeal nerve and greater auricular to internal branch of the superior laryngeal nerve anastomosis can be performed simultaneously.

Bilateral submandibular gland excision and parotid duct ligation can be combined with sensory reinnervation procedures.

There is a lack of publications on laryngeal sensory reinnervation and no pediatric outcome data in the literature.

Clinicians performing sensory reinnervation are seeing variable results in practice.

Swallowing is a combined neurological function of both motor and sensation, and while motor issues are often addressed, sensation may be ignored.

If a patient displays signs of poor sensation beyond isolated recurrent laryngeal nerve injury, reinnervating the sensory component should be considered.

Long-term results for large populations and optimal timing for sensory reinnervation are not yet clear.

Sensory reinnervation is an emerging technique that can be useful in salvage cases.