The Laryngoscope · 2026
The Effect of Interposition Nerve Graft Length on Outcomes of Laryngeal Reinnervation.
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Pillutla Pranati, Vitkovska Tereza, Weng Maxwell L, Lopez Ivan, Long Jennifer, Chhetri Dinesh K
Аннотация
OBJECTIVE: To evaluate the impact of interposition graft lengths on the efficacy of laryngeal reinnervation.
METHODS: In an in vivo rabbit model, unilateral recurrent laryngeal nerve (RLN) resection was performed followed by immediate re-anastomosis using interposition graft lengths of 0, 2, 4, and 6 cm (N = 2 animals per length). After 4 months, thyroarytenoid (TA) muscles and RLNs were harvested and analyzed. Muscle fiber area was assessed using hematoxylin-eosin staining. Neuromuscular junctions (NMJs) were identified by immunohistochemistry for post-synaptic acetylcholine receptors and categorized morphologically as pretzel shape (normally innervated), fragmented (partially innervated), or plaque-like (degenerated). Axons within RLN segments were visualized using FluoroMyelin lipid-fluorescent staining.
RESULTS: Muscle fiber area tended to be decreased on the experimental side but did not differ significantly across graft lengths. Normal contralateral muscles showed 100% pretzel morphology. NMJ morphology progressively worsened with increasing graft length: 0 cm grafts (62% pretzel; 38% fragmented; 0% plaque), 2 cm (23%; 69%; 8%), 4 cm (15%; 54%; 31%), and 6 cm (18%; 36%; 46%). Axon count in the distal RLN segment as a percentage of axons in the proximal RLN segment similarly declined with graft length: 0 cm grafts (mean 136%), 2 cm (51%), 4 cm (19%), and 6 cm (17%).
CONCLUSION: Longer interposition grafts were associated with reduced axonal counts and increasingly abnormal NMJ morphology. These findings suggest longer interposition graft lengths may reduce laryngeal reinnervation outcomes.
LEVEL OF EVIDENCE: n/a.
METHODS: In an in vivo rabbit model, unilateral recurrent laryngeal nerve (RLN) resection was performed followed by immediate re-anastomosis using interposition graft lengths of 0, 2, 4, and 6 cm (N = 2 animals per length). After 4 months, thyroarytenoid (TA) muscles and RLNs were harvested and analyzed. Muscle fiber area was assessed using hematoxylin-eosin staining. Neuromuscular junctions (NMJs) were identified by immunohistochemistry for post-synaptic acetylcholine receptors and categorized morphologically as pretzel shape (normally innervated), fragmented (partially innervated), or plaque-like (degenerated). Axons within RLN segments were visualized using FluoroMyelin lipid-fluorescent staining.
RESULTS: Muscle fiber area tended to be decreased on the experimental side but did not differ significantly across graft lengths. Normal contralateral muscles showed 100% pretzel morphology. NMJ morphology progressively worsened with increasing graft length: 0 cm grafts (62% pretzel; 38% fragmented; 0% plaque), 2 cm (23%; 69%; 8%), 4 cm (15%; 54%; 31%), and 6 cm (18%; 36%; 46%). Axon count in the distal RLN segment as a percentage of axons in the proximal RLN segment similarly declined with graft length: 0 cm grafts (mean 136%), 2 cm (51%), 4 cm (19%), and 6 cm (17%).
CONCLUSION: Longer interposition grafts were associated with reduced axonal counts and increasingly abnormal NMJ morphology. These findings suggest longer interposition graft lengths may reduce laryngeal reinnervation outcomes.
LEVEL OF EVIDENCE: n/a.