DEVELOPMENT OF A LARYNGEAL PACER

在双侧声带麻痹(BVCP)的临床障碍中， 喉的神经被切断，声带不能被绑架 (打开)在灵感中。这种危及生命的情况是由 去神经支配环状突后(PCA)肌，即 唯一的脐带外展肌肉。目前，康复方法 涉及使声带或邻近声带变形的外科手术 结构。激光定侧化和颧骨切除等手术 恢复边缘呼吸道，但两者都增加了易感性 吸入和严重的声音减弱。 最近，一些研究人员建议BVCP可以治疗 使用喉部起搏机制，这是一种功能性的 电刺激(FES)系统。尽管FES系统已经被 成功地应用于其他类型的兴奋性组织，还没有一个 为失神经肌肉开发的，因为有各种技术和 去神经肌肉独有的概念障碍。 我们广泛的初步研究表明，解剖和功能 主元分析特有的特性使其适合应用于 FES系统。此外，它还是电学研究的理想模型。 刺激失神经肌肉。从拟议的大鼠实验和 狗，将开发一种慢性刺激系统，它将恢复 去神经的PCA的外展函数。预计这一系统 将直接适用于BVCP患者，并将适应 其他神经肌肉功能障碍。

In the clinical disorder of bilateral vocal cord paralysis (BVCP), the nerves to the larynx are severed and the vocal cords cannot be abducted (opened) during inspiration. This life threatening condition is caused by denervation of the posterior cricoarytenoid (PCA) muscles, which are the sole abducting muscles of the cords. Presently, rehabilitative approaches involve surgical procedures which deform the vocal cords or adjacent structures. Operations such as laser lateralization and arytenoidectomy restore a marginal airway, but there is both increased susceptibility to aspiration and severe attenuation of the voice. Recently, a number of investigators have suggested that BVCP can be treated using a laryngeal pacing mechanism, which is a type of functional electrical stimulation (FES) system. Although FES systems have been successfully applied to other types of excitable tissue, none has been developed for denervated muscle because of a variety of technical and conceptual barriers unique to denervated muscle. Our extensive preliminary studies suggest that the anatomic and functional peculiarities specific to the PCA make it suitable for application of an FES system. Furthermore, it is an ideal model for study of electrical stimulation of denervated muscle. From the proposed experiments in rats and dogs, a chronic stimulation system will be developed which will restore abductor function to the denervated PCA. It is expected that this system will be directly applicable to patients with BVCP and will be adaptable to other disorders of neuromuscular function.