Vocal fold paralysis changes vocal fold function in two ways: the vocal fold can no longer open and close for breathing, and the muscle often atrophies or thins, leading to a weak, breathy voice.

There is no surgery that will restore the ability of a paralyzed vocal fold to open when we inhale. However, there is a procedure that supplies the atrophied muscle with nerves, restoring the tone and bulk to the vibrating vocal fold and making the voice stronger.

This procedure is known as the ansa to recurrent nerve reinnervation.  

In this procedure, the surgeon takes a branch of the ansa cervicalis, a motor nerve in the neck, and sews it to the recurrent laryngeal nerve, the nerve that gives the vocal fold mobility and tone.

While reconnecting the damaged nerve to a healthy nerve does not restore mobility to the vocal fold, it does add tone and bulk to the atrophied vocal fold.

The bulked-up vocal fold is able to vibrate better. Once this surgery is completed, the actual reinnervation of the muscle can take two to six months.

Because there is a delay in improved vocal fold tone or bulkiness, a temporary vocal fold injection is performed during the surgery to allow improved voice while the reinnervation process is taking place.

Following this procedure, if the voice still does not meet the patient’s needs, the doctor may recommend additional surgery, such as an implant to the vocal fold or an arytenoid adduction.

This article is intended as a resource for patients receiving their voice care at Duke Voice Care Center. It is not intended to substitute for medical advice from your health care team. If your doctor’s instructions differ from the information in this article, please talk with your doctor before making any changes.