RANDAL C. PANIELLO, MD
ST LOUIS, MISSOURI

The hypoglossal nerve has been shown to provide suitable temporal activity for adductory reinnervation of the larynx, and it contains many more axons than other potential donor nerves. This study sought to determine whether a single hypoglossal donor nerve could be used to restore functional laryngeal adduction to both vocal folds. In 2 dogs, both recurrent laryngeal nerves were divided low in the neck and sutured end-to-end to the right hypoglossal nerve, forming a Y anastomosis. Six months later, both dogs exhibited complete glottic closure during swallowing, followed by relaxation to a near-normal resting position, as observed on infraglottic examination. This activity was duplicated during electrical stimulation of the hypoglossal nerve, and normal measures of laryngeal adductory pressure were obtained. Induced phonation was achieved by stimulation of the hypoglossal nerve trunk while forcing air through the glottis from below. This reinnervation approach may have applications in future laryngeal transplantation efforts.