Postoperative management of superior laryngeal nerve paralysis

Abstract

Superior laryngeal nerve (SLN) injury can cause many symptoms, the most common complaints being the inability to access the upper vocal range, difficulty projecting the voice, and vocal fatigue. Treatment with voice therapy has some limited utility in these patients. Its greatest benefit may be in preventing or treating muscle tension dysphonia, developed in compensation of the SLN injury. Numerous static and one theoretical dynamic procedure have been proposed. These procedures can help augment the cricothyroid distance. These procedures may elevate the modal pitch of the voice with varying success, with only a few patients appreciating improvement in their pitch modulation. The most promising technique described is a muscle-nerve-muscle anastomosis with a neural conduit. This allows the nerve of the healthy cricothyroid muscle to innervate the paralyzed cricothyroid and ultimately leads to simultaneous bilateral muscle contraction. Although patients undergoing this procedure have shown some benefit, it has been reported only in patients who had additional procedures for voice restoration. This results in multiple confounding variables and the true utility of the procedure is unknown. Further research is needed to help identify an optimal treatment for SLN paralysis. Due to the dearth of successful treatment options, prevention of SLN injury should be emphasized.