HSC Section 6 Nov2016 Green Book
TABLE III. Stratification Analysis on Denervation Duration.
Changes Between Preoperative and Postoperative Values
P Values of Preopera- tive and Postoperative Comparison
Preoperative Median (QL, QU)
Postoperative Median (QL, QU)
P Values of Intergroups Comparison
Parameters
Groups
Overall Grade
A
2.2 (2.0–2.4)
0.0 (0.0–0.4)
< 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001
P total < 0.01
B
2.2 (2.0–2.4) 2.2 (2.0–2.4)
0.0 (0.0–0.6) 0.4 (0.2–0.7)
P ab > 0.05; P bc < 0.01
C
P ac < 0.01
Overall sample
2.2 (2.0–2.4)
0.2 (0.0–0.6)
Jitter
A
1.87 (1.44–2.66) 1.75 (1.33–2.34)
0.26 (0.21–0.35) 0.24 (0.15–0.30)
P total < 0.001
B
P ab > 0.05
C
1.85 (1.48–2.05)
0.49 (0.39–0.83)
P ac < 0.05; P bc < 0.05
Overall sample 1.82 (1.40–2.47)
0.27 (0.22–0.42) 2.86 (2.44–3.61)
Shimmer
A
9.47 (8.49–10.90)
P total < 0.001
B
9.55 (8.55–11.12)
3.12 (2.34–3.72)
P ab > 0.05; P bc < 0.05
C
9.37 (8.37–10.87)
4.82 (4.04–5.54) 3.22 (2.52–4.29)
P ac < 0.05
Overall sample 9.49 (8.49–10.90)
NHR
A
0.18 (0.14–0.29)
0.02 (0.01–0.02)
P total < 0.001
B
0.17 (0.14–0.25)
0.02 (0.01–0.02)
P ab > 0.05; P ac < 0.05
C
0.04 (0.03–0.07)
P bc < 0.05
0.20 (0.13–0.23)
Overall sample 0.18 (0.14–0.25)
0.02 (0.01–0.03)
MPT
A
6.02 (4.68–6.79) 5.59 (4.46–6.89)
17.17 (14.97–21.46) 17.37 (14.93–20.75)
P total < 0.001
B
P ab > 0.05; P ac < 0.05
C
5.45 (4.54–6.69)
14.75 (11.10–17.22)
P bc < 0.05
Overall sample 5.73 (4.60–6.79)
16.56 (14.42–20.33)
Post-VMUR
A
2.0 (1.0–2.0)
0.0 (0.0–0.0)
P total < 0.01
B
2.0 (1.0–2.0)
0.0 (0.0–0.0)
P ab > 0.05; P bc < 0.01
C
2.0 (1.0–2.0) 2.0 (1.0–2.0)
0.0 (0.0–2.0) 0.0 (0.0–1.0)
P ac < 0.001
Overall sample
Glottal closure
A
3.0 (3.0–3.0)
0.0 (0.0–0.0)
P total > 0.05
B
3.0 (3.0–3.0) 3.0 (3.0–3.0)
0.0 (0.0–0.0) 0.0 (0.0–0.0)
P ab > 0.05
C
P bc > 0.05; P ac > 0.05
Overall sample
3.0 (3.0–3.0)
0.0 (0.0–0.0)
MPT 5 maximum phonation time; NHR 5 noise-to-harmonics ratio; QL= low quartile; QU= upper quartile; VMUR 5 voluntary motor-unit recruitment. P < 0.05 is deemed as statistically significant.
ative VMUR in multivariable logistic regression analysis. In further stratification analysis, there was a significant difference between group A and C and group B and C ( P < 0.05), but not between group A and B ( P > 0.05). DISCUSSION Laryngeal reinnervation with ansa cervicalis to RLN anastomosis was reintroduced by Crumley 2 and fol- lowed by many other investigators, 4–6 and it has been presented as a good procedure to achieve a normal voice quality. Previous studies in animal models 7,10,11 and in humans 12 have shown that reinnervation can potentially restore laryngeal function when it is performed immedi- ately after RLN injury. In the clinical setting, most UVFP patients suffer from hoarseness and aspiration for several months or even years before they seek medical help. Even in UVFP patients who are diagnosed early,
regression analysis. In further stratification analysis, there was a significant difference between group A and C and group B and C (P < 0.05), but not between group A and B (P > 0.05).
Electromyographic Findings All patients received laryngeal electromyographic examinations preoperatively. However, postoperative EMG results were available in only 148, 97, and 41 patients in group A, B, and C, respectively. The electri- cal activity in the TA muscles of the affected vocal folds during EMG in the present study was divided into two types: spontaneous activity and VMUR. Spontaneous activity, which included positive waves, fibrillations, and complex repetitive discharges, could not be recorded; and VMUR were improved in each group postoperatively ( P < 0.05). Denervation duration was identified as a sig- nificant variable with regard to the parameter postoper-
Laryngoscope 124: August 2014
Li et al.: Denervated Duration on Reinnervation for UVFP
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