吻合血管的尺神经转位治疗截瘫

目的：重建胸段脊髓横断致伤完全性截瘫患者的部分周围神经功能。方法：在４例截瘫病人将一侧的尺神经自腕部切断,以骨间前神经旋前方肌支吻接远端尺神经深支,取一桡神经浅支的分支与尺神经浅支吻接,自皮下隧分段游离尺神经至腋窝起始处,分离过程中保护尺侧上副血管。于皮下将尺神经及其尺侧上副血管引人侧胸壁隧道。显露胸背动,静脉,将尺侧上副血管与其行端端吻合。在臂部分离出阴部神经、股后皮神经和坐骨神经,用带筋膜蒂股     

Quantified relationships of the radial nerve with the radial groove and selected humeral landmarks

Anatomical relationships between the radial nerve, the deltoid muscle insertions and several bony landmarks have been investigated to assess the feasibility of surgical transfer of the deltoid transfer during humeral osteotomy. Eleven embalmed human specimens were dissected. Each specimen included the whole thorax, both shoulders and upper limbs. Spatial position of the radial nerve along the radial groove, the deltoid muscle, and several anatomical landmarks was digitised using a three-dimensional (3D) digitiser. Sixteen distances and one angle characterizing the relationships between the path of the radial nerve and the landmarks were processed. Results showed that the average distance between the emergence of the radial nerve from the lateral intermuscular septum and the most distal insertion point of the deltoid muscle on the humeral bone shaft was 47.6 ± 18.5 mm. The angle between a line extending from the entry of the radial nerve into the radial sulcus and its point of emergence (REN–REM line), and on the other hand a line running from the radial emergence and the deltoid muscle tip (REM–DELTIP line) was in average 23.5 ± 6.7°. The length of four lines running perpendicular to REM–DELTIP and crossing each quarter of the REN–REM line were interpolated. The length of these four lines was, from proximal to distal, 31.3 ± 11.5 mm; 23.0 ± 7.8 mm; 16.5 ± 6.2 mm; and 7.6 ± 2.6 mm, respectively. These results described in a quantitative way the path of the radial nerve in respect to the humeral bone and the deltoid muscle. These data will be used for further development of a humeral osteotomy protocol taking into account the spatial position of the radial nerve to orientate safely the surgical tools used to cut the humeral shaft.     

Surgical anatomy of the extrapelvic part of the pudendal nerve and its applications for clinical practice

Purpose  

This study aims to report the topography of the extrapelvic part of the pudendal nerve (EPPN) and its relationship with the sacrospinous ligament and the pudendal artery.     

Location of nerve entry points of flexor digitorum profundus

The aim of this study was to elucidate the anatomical location of nerve entry points of Flexor digitorum profundus (FDP) and its implications for non-surgical neurolysis. A total of 21 amputated forearms of 11 Korean fresh cadavers were dissected. Two transverse x-axes joined the medial and lateral epicondyles and the radial and ulnar styloid processes. The longitudinal y-axis joined the midpoints of the proximal and distal transverse x-axes. The locations of the points were marked relative to the forearm length (x) and forearm width (y). The number of nerve entry points from median nerve and ulnar nerve were average 3.91 ± 0.62 (range 3–5, median 4) and 2.14 ± 0.65 (range 1–3, median 2) respectively. Most (82.9%) nerve entry points of FDP from the median nerve were within two circles, with 15 mm diameter. The two circles were on medial 1/10 of forearm width from the y-axis, and on proximal 1/3 (1:2) and 2/5 (2:3) of forearm length on x-axis. Most (80.0%) nerve entry points of the ulnar nerve innervating FDP were within a 15 × 30 mm rectangle. Its center was located at +26.5% on x-axis and −36.0% on y-axis. The nerve entry points used to be selected in performing non-surgical neurolysis with either ethyl alcohol (50%) or phenol (5–12%).     

Spinal origins of the nerve branches innervating the coracobrachialis muscle: clinical implications

The coracobrachialis muscle (Cb M) receives nerve branches from the musculocutaneous nerve (Mc N). Many textbooks describe that the Cb M is innervated by the C5, C6, and C7 spinal nerves. The present study was performed to identify the spinal nerve composition of the nerve branches innervating the Cb M and to evaluate the number of myelinated axons of the nerve branches. Two types of spinal nerve compositions were observed: type I, composed of both C6 and C7 nerves, comprised 88.9% (40/45) of the sides; and type II, composed of only C7 nerves, comprised 11.1% (5/45) of the sides. Of the type I branches, 245.4 ± 26.3 (mean ± SD, range 201–267) of the myelinated nerve fibers were derived from C6 and 520.0 ± 41.8 (range 469–567) of the fibers were derived from C7. Of the type II branches, 836.4 ± 125.5 (range 709–991) of the nerve fibers were derived from C7. Imbroglio Modometer version 2.0 was used to count the number of fibers innervating the Cb M. The main component of these nerve branches was the C7 spinal nerve. The C5 spinal nerve, did not contribute to innervating the Cb M in the present study. The number of branches varied from one to four, with C7 being concentrated in the first and second branches. Therefore, these two branches may be suitable for the neurotization procedure as a donor nerve at the upper trunk (C5 and C6) lesion of the brachial plexus.     

Anatomical basis of transgluteal pudendal nerve block

Background  The pudendal nerve may become entrapped either within the pudendal canal or near the sacrotuberous ligament resulting in a partial conduction block. The goal of the present anatomical study was to assess a new transgluteal injection technique in terms of the precise injection site and the resulting distribution of the injected agent. Materials and methods  This study was carried out using eight fresh human cadavers. An epidural needle with a removable wing was inserted and the catheter position visualized using MRI. Through the catheter 10 ml of gadolinium contrast medium was injected into three of the cadavers. A further four cadavers were injected with latex and blue pigment and the pelvi-perineal area of each then separated from the trunk for freezing before being cut into 4–8 mm thick sections with an electric bandsaw. One final cadaver was injected with a mix of gadolinium (5 ml) and latex (5 ml) and both the MRI and anatomical procedures outlined above were performed. Results  Using MRI, we clearly imaged both the site of injection, near the trunk of the pudendal nerve, and the gadolinium contrast medium in different pelvic and perineal areas and around the fascia of the obturator internus and levator ani muscle. Concerning the anatomical study, latex was observed mainly around the sacrotuberous ligament, along the obturator internus muscle and in the perineal area in contact with the dividing branches of the pudendal nerve. The mixed injection of latex and gadolinium in the pudendal canal was found with the same localization between MRI and anatomical studies. Conclusion  This easily performed technique should provide a new approach for treating perineal neuralgia via pudendal nerve block in the consultation room without the need for computed tomography.     

带血管神经蒂股薄肌瓣重建尿道括约肌的应用解剖

目的为带血管神经蒂股薄肌瓣转位重建尿道括约肌术提供解剖学基础。方法在35例成人下肢标本上,对股薄肌的形态、主要血管、神经的来源,血管神经蒂的长度、入肌部位等进行解剖观测。结果股薄肌全长(42.0±0.6)cm,肌腹长(31.0±3.8)cm;肌腱长(10.9±0.9)cm;股薄肌的血供主要来源于股深动脉的股薄肌支,该分支起始处外径(2.1±0.6)mm,血管蒂长(9.2±0.9)cm,入肌部位在股薄肌中、上1/3交界处前缘的深面;股薄肌的神经支配,均恒定地来自闭孔神经前支,该神经在闭膜管处,横径为(1.7±0.4)mm;厚(0.5±0.2)mm,从闭膜管至入肌点处长(10.4±1.4)cm。结论带血管神经蒂股薄肌瓣转位重建尿道括约肌术,经尸体摹拟实验,证明具有可行性。     

Fecal incontinence. Studies on physiology,pathophysiology and surgical treatment

The thesis consists of ten previously published studies and a review. The physiological and pathophysiological mechanisms in fecal incontinence has been studied by anal manometry, both by standard static anal manometry and by a new method, dynamic anal manometry, where anal sphincter pressure can be measured during simultaneous opening and closing of the anal canal. Patients with fecal incontinence showed abnormal sphincter pressures more frequently when dynamic anal manometry was used compared to standard anal manometry. The physiology and pathophysiology of the rectum was studied using rectal compliance measurements. Patients with normal anorectal function had a large variation in rectal compliance. Patients with fecal incontinence had as a group, lower rectal compliance than continent patients. This may lead to increased frequency of incontinence episodes in patients with fecal incontinence. The relationship between idiopathic fecal incontinence and pudendal nerve terminal latency was studied in 178 patients. The far majority of patients had normal latencies, and there was no correlation between latency and anal manometry. In contrast to previous suggestions, idiopathic fecal incontinence does not seem to be caused by pudendal nerve damage. Reconstruction of the external anal sphincter in patients with fecal incontinence due to obstetric sphincter lesion showed a poorer functional result among patients older than forty years compared to younger. This indicates that the general muscular weakening with age contribute to the incontinence in these patients. The treatment of more complicated forms of fecal incontinence consists of, apart from conservative treatment or colostomi, mainly in muscle transpositions or artificial anal sphincter. Transposition of the distal part of the gluteus maximus muscle to encircle the anal canal, did not lead to acceptable continence in any of the patients studied. Transposition of the gracilis muscle lead to acceptable continence in half the patients. Patients where the transposed muscle were stimulated by a neurostimulator had satisfactory continence in most cases. However, with this method several re-operations were necessary in some patients. In addition, some patients developed severe evacuation difficulties. Implantation of an artificial sphincter resulted in long-term improvement of continence in that half of patients in whom the artificial sphincter remained implanted. The other half of the patients had the artificial sphincter explanted due to various reasons, most frequently due to infection around the device. In selected patients with more complicated fecal incontinence, stimulated gracilis transposition or implantation of an artificial anal sphincter may be offered as an alternative to colostomy. Sacral nerve stimulation is a new method which seems to provide the best results among the more advanced procedures. Its minimally invasive character also contribute to the increasing use of this method in the last few years. Evaluation and treatment of fecal incontinence is presently in a state of rapid change with focus on more elaborate investigative methods and more diversified treatment.     

第九、十、十一肋间神经和肋下神经与阴部神经吻接术治疗截瘫的应用解剖

在供研究用的20具(男13女7)成人尸体上,对40侧九、十、十一肋间神经和肋下神经进行了应用解剖研究。可取长度平均值分别为111.11mm。100.88mm,81.28mm,和64.20mm,分支处的宽、厚度平均值分别为2.59和1.12mm,2.58和0.08mm,2.89和0.10mm,3.49和1.04mm。游离切断各肋间神经远侧端,在肩胛线上垂直下拉,观察了其末端与腰椎棘突的对应关系,并测量了其与阴部神经出盆处之间的距离。阴部神经长度及出盆处的宽、厚度平均值分別为31.35mm,4.87mm和1.59mm。本文认为用带血管蒂的腓肠神经作为供体桥接下位肋间神经与阴部神经,为截瘫病人的外科治疗提供了一种新的方法。     

阴部神经的解剖学观测及其临床意义

目的　从神经胚胎发育的角度对阴部神经的来源、组成、走行、分支进行解剖学观测,为临床会阴部手术提供依据。 方法　16具（32侧）成人尸体标本解剖观察阴部神经的组成、形态、走行、分支及其毗邻关系,测量阴部神经与毗邻结构距离等的数据。 结果　阴部神经主要由S2、S3和S4前支混合后组成,但仍有部分由S2和S3前支混合后组成。阴部神经在下行过程中有坐骨神经及股后皮神经的分支加入,三者之间相互交通的关系较为复杂;在阴部管及坐骨直肠窝,阴部神经的毗邻不同;阴部神经分为盆内和盆外分支。阴部神经在阴部管内距坐骨结节前缘下方的距离为（男25.47±3.18 mm, 女26.38±2.56 mm）;阴部神经在坐骨棘处距皮肤的距离为（男75.67±8.37 mm, 女76.89±9.48 mm）。 结论　阴部神经与毗邻神经交通复杂,细致的解剖对临床相关手术及治疗具有指导意义。     

Number of fibres and fibre diameter distributions of nerves innervating the urinary bladder in humans. Acceptor nerve analysis. II.(IV).

1. The nerves innervating the urinary bladder were analysed morphometrically for their nerve fibre number and their nerve fibre group composition. 2. The nervi pelvini contained about 4000 myelinated nerve fibres, the nervi rectales inferiores and perineales 1700 and the nervus hypogastricus 2000 fibres. 3. An upper limit for somatic sphincteric alpha 2-motoneurons was 30 in the nervi rectales inferiores and perineales. The nervi pelvini contained about 400 fibres with diameters between 7 and 15 microns and myelin sheath thicknesses between 1.8 and 2.3 microns. Some of these thick nerve fibres could innervate the external urethral sphincter. It is estimated that the number of efferent parasympathetic fibres in the nervi pelvini on one side was about 800, which makes about 20% of all the myelinated fibres of the nervi pelvini. 4. It is discussed that efferent fibres to the external bladder sphincter may lead through the nervi pelvini or a direct branch instead of leading through the pudendal nerve. 5. In the Clinical Implications it is summarized that one intercostal nerve (9000 afferents, 1000 efferents) with its dissectable skin (3000 aff), muscle (300 aff, 300 eff) and mixed branches (2500 aff, 1500 eff) contains enough myelinated fibres for a reinnervation of the detrusor (3200 aff, 800 eff), the external anal and bladder sphincters (30 aff, 30 eff), the mucosa of the urethra, trigonum vesicae and anal canal (200 aff) and the lower sacral skin (6000 aff) on one side if one intends to restorate urinary bladder function in paraplegia by a nerve anastomosis. Reasons for a loss of plasticity of the injured spinal cord are given.     

Investigation of differentially expressed proteins in rat gastrocnemius muscle during denervation–reinnervation

To have a better insight into the molecular events involved in denervation-induced atrophy and reinnervation-induced regeneration of skeletal muscles, it is important to investigate the changes in expression levels of a great multitude of muscle proteins during the process of denervation–reinnervation. In this study, we employed an experimental model of rat sciatic nerve crush to examine the differentially expressed proteins in the rat gastrocnemius muscle at different time points (0, 1, 2, 3, 4 weeks) after sciatic␣nerve crush by using two-dimensional gel electrophoresis (2-DE) followed by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF-MS), collectively referred to as the modern proteomic analysis. The results showed that 16 proteins in the rat gastrocnemius muscle exhibited two distinct types of change pattern in their relative abundance: (1) The relative expression levels of 11 proteins (including alpha actin, myosin heavy chain, etc.)were decreased either within 1 or 2 weeks post-sciatic nerve injury, followed by restoration during the ensuing days until 4 weeks. (2) The other 5 proteins (including alpha enolase, beta enolase, signal peptide peptidase-like 3, etc.) displayed an up-regulation in their relative expression levels within 1 week following sciatic nerve injury, and a subsequent gradual decrease in their relative expression levels until 4 weeks. Moreover, the significance of the changes in expression levels of the 16 proteins during denervation–reinnervation has been selectively discussed.     

Effects of Chronic Hypotension on the Adrenergic Nervous Plexus of the Saphenous Artery in Rats and Its Regeneration after Femoral Nerve Injury

The effects of chronic hypotension on the density and intensity of fluorescence (after treatment with glyoxylic acid) of the plexus of adrenergic fibers in the wall of the saphenous artery and on the reinnervation of this vessel were studied in Wistar rats. Regional hypotension in the vascular bed of the hind part of the rats’ bodies was induced by stenosis of the abdominal part of the aorta distal to the renal arteries. After four weeks, the saphenous artery was denervated in one limb by resection of a segment of the femoral nerve. In the limb with the nerve lesion, chronic (6–7 weeks) hypotension led to a reduction in the intensity of nerve fiber fluorescence by 20% as compared with normotensive animals (controls), though the density of the nerve plexus did not change. Partial reinnervation of the vessel was observed 2–3 weeks after femoral nerve lesioning. Measures of reinnervation in normotensive and hypotensive rats were no different at two weeks, though at three weeks rats with hypotension showed more complete recovery of innervation.     

闭孔神经与阴部神经缝接治疗截瘫后的大小便失禁

在目前还无法使损伤的脊髓再生的情况下,我们在15具成人尸体上做了应用解剖学的的研究。试图用闭孔神经的分支改道修复阴部神经的主要功能支,以修复低位的脊髓损伤和尾神经损伤所致的大小便失禁。并初步过渡到临床,完成1例手术。     

Proposed surgical technique to facilitate targeted reinnervation of the infraspinatus: A cadaveric feasibility study

Restoration of shoulder lateral rotation remains a significant challenge following brachial plexus injury. Transfer of the accessory nerve to suprascapular nerve (SSN) has been widely performed, although with generally poor outcomes for lateral rotation. A recent report suggested a selective infraspinatus reinnervation technique using a radial nerve branch for SSN transfer. This cadaveric study was performed in 7 specimens (14 shoulders). We present technical modifications to achieve additional length to the recipient nerve (suprascapular) that would facilitate direct repair. Key elements of the technique are (1) isolation of the SSN immediately distal to its motor branch to supraspinatus near the superior transverse scapular ligament; and (2) delivery of the transected SSN through the spinoglenoid notch and deep to the infraspinatus for emergence in the infraspinatus‐teres minor interval. Nerve overlap of at least 21 mm was observed in all 14 dissected shoulders between the harvested SSN and radial nerve branches. The mean nerve overlap between harvested branches was 26 mm (range 21–32 mm). The mean harvested SSN length was 59 mm (range 46–80 mm). The mean length of the harvested radial nerve branch was 72 mm (range 65–85 mm). No measurements were significantly different between left and right shoulders or between males and females (smallest P value = 0.1249). Nerve diameter of the two harvested branches was judged to be appropriately compatible for surgical coaptation in all 14 dissected shoulders. We present a variation on a described technique to increase recipient suprascapular nerve length. Additional length of the recipient nerve is achieved through utilization of a more proximal dissection of the suprascapular nerve near the level of the superior transverse scapular ligament and delivering the nerve through the teres minor‐infraspinatus interval. These surgical modifications are of clinical interest when selective reinnervation of the infraspinatus muscle is considered. We believe such a targeted approach can potentially increase shoulder lateral rotation function. Clin. Anat. 32:131–136, 2019. © 2018 Wiley Periodicals, Inc.     

CT-scan imaging of iron marked chorda tympani nerve: anatomical study and educational perspectives

The chorda tympani nerve (CTN) is the last collateral branch of the facial nerve in its third intraosseous portion just over the stylomastoid foramen. After a curved course against the medial aspect of the tympanum where it is likely to be injured in middle ear surgery, CTN reaches the lingual nerve in the infratemporal fossa. Knowledge of CTN topographic anatomy is not easily achieved by the students because of the deep location of this thin structure. The aim of this study was to assess the spatial relationships of the CTN in the infratemporal fossa. Therefore, ten nerves were dissected in five fresh cadavers. All the nerves were catheterized with a 3/0 wire. After a meticulous repositioning of surrounding structures, standard X-ray and CT scan examinations were performed with multiplanar acquisitions and three-dimensional surface rendering reconstructions. Ventral projection of the CTN corresponded to the middle of the maxillary sinus. Lateral landmark was the mandibular condyle. The CTN was present and unique in all the dissections. The average length of the nerve, as measured on CT scans, was 31.8 mm (29–34, standard deviation of 1.62); the anastomosis of the CTN to the lingual nerve was located at a mean 24.9 mm below the skull base (24–27, standard deviation of 0.99), approximately in the same horizontal plane as the lower part of the mandibular notch. The acute angle opened dorsally and cranially between CTN and LN measured mean 63.2° (60–65, standard deviation of 1.67). Three-dimensional volumetric reconstructions using surface rendering technique provided realistic educational support at the students’ disposal.     

Donor, recipient and nerve grafts in brachial plexus reconstruction: anatomical and technical features for facilitating the exposure

Forty three cadavers of adult and five patients were included in our study. Accessory, suprascapular, musculocutaneous and sural nerves were dissected. These widely used nerves in brachial plexus reconstruction have varying anatomy and still have no standard approach for surgery. Dissection of the accessory nerve in the upper part of the posterior neck triangle was quite complicated took a relatively long time and the nerve could easily be injured. It was found that these shortcomings could be diminished starting dissection of this nerve in the lower part of the posterior neck triangle near the anterior border of trapezius muscle 2 cm (0–3.5) above the clavicle. Accessory nerve entered inner surface of this muscle 3 cm (1–4) from this edge. The proximal portion of the suprascapular nerve was not difficult to identify if post-traumatic scarring is absent. Alternative approach was starting dissection from the junction of C5 and C6 into superior trunk. The suprascapular nerve diverged distally from this junction at 2 cm (0–2.5). The proximal portion of the musculocutaneous nerve was identified by cutting clavicle or tendon of major pectoral muscle. Quicker and less traumatic exposure of this nerve was starting dissection in the bed between biceps and coracobrachialis muscles. The first branches of the musculocutaneous nerve to the biceps brachii muscle took onset 4 cm (3.5–6) distally from the lower margin of the tendon of major pectoral muscle. First branch to the brachial muscle originated from the musculocutaneous nerve distally from the same tendon at 9.4 cm (6.1–10.5). Two main but controversial principles exist in sural nerve graft dissection: time saving and less traumatic approach. Long nerve graft is necessary during brachial plexus reconstruction when many interposition grafts are needed. Technique of multiple (4–7) transverse skin incisions let us to get sural nerve with both branches as long as 66 cm (average 47 cm). Total length of this nerve mainly depended on branching level, which was found to be 27.5 cm (9–35) measuring proximally from the lateral ankle.     

Real-time waveform analysis of multichannel nerve impulses with a multimicroprocessor system

A new system for the online real-time waveform separation of the nerve impulses recorded from multichannel extracellular electrodes placed to the peripheral nerve trunk has been developed using two microprocessors and a graphics computer. One microprocessor (Intel 8085) performs nerve impulse detection and the other (Intel 8086) separates nerve impulses by clustering in the two-dimensional histograms representing the distribution of the parameters extracted from their waveforms. System performance was examined with two channel impulses recorded from the nerve trunk innervating the Sartorius muscle of a frog. These data could be classified into 6–8 different groups in real time.     

The topographical relationships and anastomosis of the nerves in the human internal auditory canal

Introduction The anatomy of the nerves in the human internal auditory canal (IAC) has been reported by a number of authors, and there are some differences among the viewpoints of the literatures. With the development of the microsurgery and endoscopic surgery in the IAC, the study of the topographical relationship of the nerves in the human IAC becomes more and more important. The purpose of this study was to investigate the anastomosis and topographical relationship of the nerves in the human IAC. Methods In this study, we dissected 30 human temporal bones from 15 heads, and examined the topographical relationship and the anastomosis of the nerves in human IAC. Results (1) In 11 out of 30 cases (37%), the facial nerve is anterosuperior to the vestibulocochlear nerve through the whole IAC; and for the remaining 19 cases (63%), the facial nerve rotates anteroinferiorly at an angle ranging from 30° to 90°, which is in the same direction as that of the cochlear. (2) Vestibulofacial nerve anastomosis occurs in 25 cases (83%), of which 67% appears near the porus acusticus, and of which 33% appears between the lateral and intermedial portion of IAC. The diameter was about 0.5–1 mm. (3) Vestibulocochlear anastomosis occurs in 24 cases (80%) among which, some brush-like nerve fiber bundles of the cochlear nerve were seen to enter the acculus proprius directly in 13 cases. Transverse vestibulocochlear anastomosis in the fundus of internal acoustic meatus occurred in 15 cases, including two cases with more anastomosis. No vestibulocochlear nerve anastomosis was found in six cases in this study. Conclusions Our study shows that the Vestibulofacial nerve anastomosis and the vestibulocochlear nerve anastomosis do exist, and some variations appear due to individual differences. The appearance of the facial and vestibulocochlearnerves is variable but follows certain consistent patterns.     

Electrical stimulation of a denervated muscle promotes selective reinnervation by native over foreign motoneurons

The effect of electrical stimulation of the denervated posterior cricoarytenoid (PCA) muscle on its subsequent reinnervation was explored in the canine. Eight animals were implanted with a planar array of 36 electrodes for chronic stimulation and recording of spontaneous and evoked electromyographic (EMG) potentials across the entire fan-shaped surface of a muscle pair. Normative EMG data were recorded from each electrode site before unilateral nerve section, and from the innervated partner after nerve section. After randomizing the animals to experimental and control groups, the right recurrent laryngeal nerve innervating the PCA abductor muscle and its adductor antagonists was sectioned and reanastomosed. The PCA muscle in four experimental animals was continuously stimulated during the 11-mo experiment, using a 1-s, 30-pps, biphasic pulse train composed of 1-ms pulses 2-6 mA in amplitude and repeated every 10 s. The remaining four animals served as nonstimulated controls. Appropriate reinnervation by native inspiratory motoneurons was indexed behaviorally by the magnitude of vocal fold opening and electromyographically by the potential across all electrode sites. Inappropriate reinnervation by foreign adductor motoneurons was quantitated by recording EMG potentials evoked reflexly by stimulation of sensory afferents of the laryngeal mucosa. All four experimental animals showed a greater level of correct PCA muscle reinnervation (P < 0.0064) and a lesser level of incorrect reinnervation (P < 0.0084) than the controls. Direct muscle stimulation also appeared to enhance the overall magnitude of reinnervation, but the effect was not as strong (P < 0.113). These findings are consistent with a previous report and suggest that stimulation of a mammalian muscle may profoundly affect its receptivity to reinnervation by a particular motoneuron type.