Neuromuscular Junctions

Once the branches of the RLN and SLN enter the appropriate muscles, they interface at the neuromuscular junctions (NMJ). The morphology of the NMJs have been classified as plate-like, grape-like, or complex, all of which have been identified in the PCA, IA, TA, and CT muscles [63]. The TA muscle is principally comprised of the complex motor end plates. In addition, the TA muscle has a higher incidence of double NMJs on a given muscle fiber. These dual NMJs are always innervated by the same nerve. In older larynges there is evidence of neurons innervating adjacent NMJs which have lost there native innervation [63]. Initial studies of the TA distribution of NMJs found a relatively scattered distribution within the thyroarytenoid muscle [63, 64]. Sheppert et al. [65] looked at the NMJs in the TA muscle using immunolabeled anti-synaptophysin antibody. They found 75% of the NMJs distributed among the middle one-third of the TA in an anterior/posterior dimension with relative even distribution in the superior/inferior dimension. Examination of the LCA found consistent distribution of NMJs in the mid portion of the muscle [66, 67]. The NMJs in the PCA muscle form an arc-like distribution [68] which is less consistent than in the other muscles, and appears to be related to the distribution among the two bellies of the PCA muscle. Staining of the cricothyroid muscle revealed a propensity of the NMJs for the medial two-thirds of the muscle with minimal staining at the extreme ends [21].

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