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The functional role of the pharyngeal plexus in vocal cord innervation in humans

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Abstract

Classical understanding of the function of the pharyngeal plexus in humans is that it relies on both motor branches for innervation of the majority of pharyngeal muscles and sensory branches for the pharyngeal wall sensation. To date there has been no reported data on the role of the pharyngeal plexus in vocal cord innervation. The aim of this study is to evaluate whether or not the plexus pharyngeus contributes to the innervation of the vocal cords. One hundred twenty-five sides from 79 patients (59 female, 20 male) undergoing thyroid surgery with intraoperative neuromonitoring were prospectively evaluated. While vocal cord function was evaluated with endotracheal tube surface electrodes, cricothyroid and cricopharyngeal muscle electromyographic recordings were obtained with a pair of needle electrodes. The ipsilateral pharyngeal plexus, external branch of the superior laryngeal nerve, and recurrent laryngeal nerve were stimulated with a monopolar probe at 1 mA. With stimulation of the plexus pharyngeus on 125 operated sides, positive electromyographic waveforms were detected from five ipsilateral vocal cords (accounting for 3.2% of all vocal cords monitored and 6.3% of patients). The mean EMG amplitude of the vocal cords with stimulation of the plexus pharyngeus was 147 ± 35.5 μV (range 110–203). In one case, the long latency time of 19.8 ms correlated with innervation by the glottic closure reflex pathway. The short latencies seen in the other four cases [3.9 ± 1.1 ms (range 3.2–5.5)] correlated with direct innervation. In some cases, the plexus pharyngeus may contribute to vocal cord innervation by reflex or direct innervation patterns in humans.

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Authors and Affiliations

  1. General Surgery Department, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey

    Mehmet Uludag & Nurcihan Aygun

  2. General Surgery Department, Bahcesehir University Medical Faculty, Istanbul, Turkey

    Adnan Isgor

Authors
  1. Mehmet Uludag
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  2. Nurcihan Aygun
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  3. Adnan Isgor
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Correspondence to Mehmet Uludag.

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All authors have agreed to the manuscript’s content. All authors warrant that the submitted article is original, and has not been submitted to another journal for publication, has not been published elsewhere, or if published in whole or in part, all permissions were granted for publication in Langenbeck’s Archives of Surgery.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. This prospective study was approved by the Institutional Review Board of Sisli Hamidiye Etfal Training and Research Hospital.

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Informed consent was obtained from all individual participants included in the study.

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Uludag, M., Aygun, N. & Isgor, A. The functional role of the pharyngeal plexus in vocal cord innervation in humans. Eur Arch Otorhinolaryngol 274, 1121–1128 (2017). https://doi.org/10.1007/s00405-016-4369-7

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  • DOI: https://doi.org/10.1007/s00405-016-4369-7

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