Primary and Delayed Non-Selective Laryngeal Reinnervation in Unilateral Vocal Fold Paralysis: A Single Tertiary Center Experience.

BACKGROUND

Non-selective laryngeal reinnervation (NSLR) is performed for unilateral vocal fold paralysis (UVFP) either as a primary procedure following recurrent laryngeal nerve (RLN) injury during thyroidectomy or as a delayed intervention after established paralysis. Although both approaches have demonstrated favorable voice outcomes, comparative evidence regarding their long-term effectiveness remains limited.

OBJECTIVE

To evaluate and compare multidimensional voice outcomes between primary and delayed NSLR in patients with UVFP.

METHODS

Twenty-five patients were analyzed and categorized into primary (n = 11) and delayed (n = 14) groups. In the delayed group, neurogenic paralysis was confirmed using preoperative laryngeal electromyography and mobile cricoarytenoid joint on palpation prior to surgery. Multidimensional voice outcomes were assessed at baseline, 6 months, and 12 months, postoperatively. Statistical comparisons across timepoints were performed using Friedman and Wilcoxon signed-rank tests. Baseline parameters and 12-month outcomes between groups were compared using the Mann-Whitney U test.

RESULTS

Overall, significant improvements were observed in all multidimensional voice outcomes across timepoints (P < 0.05). The mean Bahasa Malaysia Voice Handicap Index-10 (mVHI-10) score improved from 18.40 to 7.01 at 12 months, while maximum phonation time (MPT) increased from 8.10 to 12.97 seconds. At 12 months, 80% of patients achieved normal to near-normal voice (mVHI-10 ≤ 11). In the primary group, significant improvements in mVHI-10 and MPT were observed at 12 months, with acoustic parameters remaining stable. The delayed group demonstrated significant improvements in all measured parameters at both 6 and 12 months. Although the primary group showed lower mean mVHI-10 scores and longer MPT at 12 months compared with the delayed group, these differences were not statistically significant.

CONCLUSION

Both primary and delayed NSLR significantly improve multidimensional voice outcomes in UVFP. While early intervention may preserve near-normal voice function, delayed reinnervation remains effective, supporting NSLR as a viable treatment option regardless of timing in appropriately selected patients.