SLAD-R: A surgical option for treatment of spasmodic dysphonia

The Selective Laryngeal Adductor Denervation-Reinnervation (SLAD-R) was pioneered by Dr. Gerald Berke at UCLA that focuses on the treatment of the tiny nerve branches that go to the individual muscles involved in AdSD.

The overall procedure is accomplished through an incision in the neck, which creates a small window into the laryngeal cartilage to expose the underlying nerves and muscles. An operating microscope is often used to aid in identification and suturing of the tiny nerve branches.

Next, the surgeon connects an unaffected nerve to the cut stumps of the nerves treated in denervation. This process, known as “reinnervation,” prevents the weakened muscles from atrophy and also blocks the denervated nerve branch from reconnecting and the spasms from returning. Great care is taken to preserve the back part of the cartilage that protects the nerve branches to the breathing muscles. The overall procedure takes three to four hours to complete and is performed under general anesthesia.

A hospital stay of one to three days is usually required. Some people have initial difficulty swallowing because doctors are borrowing from the swallow nerve, so swallowing is temporarily impacted, however, the reflex usually recovers within the first day. 

You may find that you will no longer be able to yell or project your voice. In addition, the nerve that controls pitch is often affected and that can making singing challenging.