Reinnervation of the diaphragm by the inferior laryngeal nerve to the phrenic nerve in ventilator-dependent tetraplegic patients with C3-5 damage
The aim of this study was to evaluate the feasibility of unilateral diaphragmatic reinnervation in humans by the inferior laryngeal nerve. This pilot study included chronically ventilated tetraplegic patients with destruction of phrenic nerve motoneurons. Five patients were included. They all had a...
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| Format: | Article |
| Language: | English |
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European Respiratory Society
2017-11-01
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| Series: | ERJ Open Research |
| Online Access: | http://openres.ersjournals.com/content/3/4/00052-2017.full |
| _version_ | 1818937338399555584 |
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| author | Eric Verin Capucine Morelot-Panzini Jesus Gonzalez-Bermejo Benoit Veber Brigitte Perrouin Verbe Brigitte Soudrie Anne Marie Leroi Jean Paul Marie Thomas Similowski |
| author_facet | Eric Verin Capucine Morelot-Panzini Jesus Gonzalez-Bermejo Benoit Veber Brigitte Perrouin Verbe Brigitte Soudrie Anne Marie Leroi Jean Paul Marie Thomas Similowski |
| author_sort | Eric Verin |
| collection | DOAJ |
| description | The aim of this study was to evaluate the feasibility of unilateral diaphragmatic reinnervation in humans by the inferior laryngeal nerve. This pilot study included chronically ventilated tetraplegic patients with destruction of phrenic nerve motoneurons. Five patients were included. They all had a high level of tetraplegia, with phrenic nerve motor neuron destruction. They were highly dependent on ventilation, without any possibility of weaning. They did not have other chronic pathologies, especially laryngeal disease. They all had diaphragmatic explorations to diagnose the destruction of the motoneurons of the phrenic nerves and nasoendoscopy to be sure that they did not have laryngeal or pharyngeal disease. Then, surgical anastomosis of the right phrenic nerve was performed with the inferior laryngeal nerve, by a cervical approach. A laryngeal reinnervation was performed at the same time, using the ansa hypoglossi. One patient was excluded because of a functional phrenic nerve and one patient died 6 months after the surgery of a cardiac arrest. The remaining three patients were evaluated after the anastomosis every 6 months. They did not present any swallowing or vocal alterations. In these three patients, the diaphragmatic explorations showed that there was a recovery of the diaphragmatic electromyogram of the right and left hemidiaphragms after 1 year. Two patients had surgical diaphragmatic explorations for diaphragmatic pacing 18–24 months after the reinnervation with excellent results. At 36 months, none of the patients could restore their automatic ventilation. In conclusion, this study demonstrated that diaphragmatic reinnervation by the inferior laryngeal nerve is effective, without any vocal or swallowing complications. |
| first_indexed | 2024-12-20T05:50:22Z |
| format | Article |
| id | doaj.art-ecfde2c05fda4d269b1058a1a72d890d |
| institution | Directory Open Access Journal |
| issn | 2312-0541 |
| language | English |
| last_indexed | 2024-12-20T05:50:22Z |
| publishDate | 2017-11-01 |
| publisher | European Respiratory Society |
| record_format | Article |
| series | ERJ Open Research |
| spelling | doaj.art-ecfde2c05fda4d269b1058a1a72d890d2022-12-21T19:51:12ZengEuropean Respiratory SocietyERJ Open Research2312-05412017-11-013410.1183/23120541.00052-201700052-2017Reinnervation of the diaphragm by the inferior laryngeal nerve to the phrenic nerve in ventilator-dependent tetraplegic patients with C3-5 damageEric Verin0Capucine Morelot-Panzini1Jesus Gonzalez-Bermejo2Benoit Veber3Brigitte Perrouin Verbe4Brigitte Soudrie5Anne Marie Leroi6Jean Paul Marie7Thomas Similowski8 EA 3830, Normandy University, Groupe de recherche sur le handicap ventilatoire (GRHV), Université de Rouen, Rouen, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département “R3S”), Paris, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département “R3S”), Paris, France Service de réanimation chirurgicale, CHU de Rouen, Rouen, France Service de MPR, CHU de Nantes, Nantes, France SSR Handicap Lourd, Hopital marin, Hendaye, France Service de physiologie, CHU de Rouen, Rouen, France EA 3830, Normandy University, Groupe de recherche sur le handicap ventilatoire (GRHV), Université de Rouen, Rouen, France AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département “R3S”), Paris, France The aim of this study was to evaluate the feasibility of unilateral diaphragmatic reinnervation in humans by the inferior laryngeal nerve. This pilot study included chronically ventilated tetraplegic patients with destruction of phrenic nerve motoneurons. Five patients were included. They all had a high level of tetraplegia, with phrenic nerve motor neuron destruction. They were highly dependent on ventilation, without any possibility of weaning. They did not have other chronic pathologies, especially laryngeal disease. They all had diaphragmatic explorations to diagnose the destruction of the motoneurons of the phrenic nerves and nasoendoscopy to be sure that they did not have laryngeal or pharyngeal disease. Then, surgical anastomosis of the right phrenic nerve was performed with the inferior laryngeal nerve, by a cervical approach. A laryngeal reinnervation was performed at the same time, using the ansa hypoglossi. One patient was excluded because of a functional phrenic nerve and one patient died 6 months after the surgery of a cardiac arrest. The remaining three patients were evaluated after the anastomosis every 6 months. They did not present any swallowing or vocal alterations. In these three patients, the diaphragmatic explorations showed that there was a recovery of the diaphragmatic electromyogram of the right and left hemidiaphragms after 1 year. Two patients had surgical diaphragmatic explorations for diaphragmatic pacing 18–24 months after the reinnervation with excellent results. At 36 months, none of the patients could restore their automatic ventilation. In conclusion, this study demonstrated that diaphragmatic reinnervation by the inferior laryngeal nerve is effective, without any vocal or swallowing complications.http://openres.ersjournals.com/content/3/4/00052-2017.full |
| spellingShingle | Eric Verin Capucine Morelot-Panzini Jesus Gonzalez-Bermejo Benoit Veber Brigitte Perrouin Verbe Brigitte Soudrie Anne Marie Leroi Jean Paul Marie Thomas Similowski Reinnervation of the diaphragm by the inferior laryngeal nerve to the phrenic nerve in ventilator-dependent tetraplegic patients with C3-5 damage ERJ Open Research |
| title | Reinnervation of the diaphragm by the inferior laryngeal nerve to the phrenic nerve in ventilator-dependent tetraplegic patients with C3-5 damage |
| title_full | Reinnervation of the diaphragm by the inferior laryngeal nerve to the phrenic nerve in ventilator-dependent tetraplegic patients with C3-5 damage |
| title_fullStr | Reinnervation of the diaphragm by the inferior laryngeal nerve to the phrenic nerve in ventilator-dependent tetraplegic patients with C3-5 damage |
| title_full_unstemmed | Reinnervation of the diaphragm by the inferior laryngeal nerve to the phrenic nerve in ventilator-dependent tetraplegic patients with C3-5 damage |
| title_short | Reinnervation of the diaphragm by the inferior laryngeal nerve to the phrenic nerve in ventilator-dependent tetraplegic patients with C3-5 damage |
| title_sort | reinnervation of the diaphragm by the inferior laryngeal nerve to the phrenic nerve in ventilator dependent tetraplegic patients with c3 5 damage |
| url | http://openres.ersjournals.com/content/3/4/00052-2017.full |
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