Local neurotoxins for prevention of laryngeal synkinesis after recurrent laryngeal nerve injury

Bryan R. McRae, John C. Kincaid, Elisa A. Illing, Kelly K. Hiatt, Jan F. Hawkins, Stacey L. Halum

Research output: Contribution to journalArticle

14 Scopus citations


Objectives: Persistent vocal fold motion impairment after recurrent laryngeal nerve (RLN) injury is not characteristically due to absent reinnervation, but often results from spontaneous aberrant reinnervation (synkinesis). We administered local neurotoxins to selected laryngeal muscles after RLN injury to determine whether aberrant reinnervation could be selectively inhibited. Methods: Unilateral RLN transection was performed in 24 male rats. Three weeks later, the denervated laryngeal adductor complex was injected with phenol, high- or low-dose vincristine sulfate (VNC), or saline solution. One month later, rat larynges were evaluated via videolaryngoscopy and laryngeal electromyography (LEMG). Larynges from euthanized animals were analyzed via immunofluorescent staining for the presence of reinnervation. Results: One animal that received phenol and 3 animals that received high-dose VNC died of toxicity-related complications. In the surviving neurotoxin-treated animals, videolaryngoscopy showed increased lateralization of the immobile vocal fold. Only 1 phenol-injected rat had adductor complex motor recruitment (score of 3+) with LEMG. The other neurotoxin-treated animals demonstrated an absence of adductor complex reinnervation, with only insertional activity and fibrillations (no motor units/recruitment). Spontaneous ipsilateral abductor reinnervation was not affected by the adductor injections. Conclusions: Low-dose VNC injections appear to be relatively safe and effective in selectively inhibiting spontaneous aberrant reinnervation after RLN injury in an animal model.

Original languageEnglish (US)
Pages (from-to)887-893
Number of pages7
JournalAnnals of Otology, Rhinology and Laryngology
Issue number12
StatePublished - Dec 2009


  • Larynx
  • Recurrent laryngeal nerve
  • Synkinesis
  • Vincristine
  • Vocal fold motion impairment
  • Vocal fold paralysis

ASJC Scopus subject areas

  • Otorhinolaryngology

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