A method to repair the recurrent laryngeal nerve during thyroidectomy

Area of Science:

• Otolaryngology
• Head and Neck Surgery
• Thyroid Surgery

Background:

• Vocal cord palsy (VCP) is a common complication after thyroidectomy.
• Recurrent laryngeal nerve (RLN) injury can lead to significant voice impairment.
• Intraoperative management of iatrogenic RLN injury is crucial for functional outcomes.

Purpose of the Study:

• To evaluate the outcomes of immediate intraoperative reconstruction of the recurrent laryngeal nerve (RLN).
• To assess voice quality and aspiration in patients undergoing RLN repair following thyroidectomy.

Main Methods:

• Retrospective analysis of 917 thyroidectomy patients (2000-2015).
• Identified 12 patients with RLN injury, categorized into two groups based on intraoperative findings or postoperative VCP.
• Group A (n=5) underwent immediate microsurgical primary RLN repair; outcomes assessed via subjective (voice, aspiration) and objective (GRBAS scale, laryngoscopy) measures at 3 and 9 months.

Main Results:

• In Group A, significant improvements in roughness, breathiness, and strain were observed at 9 months compared to 3 months post-repair (p < 0.05).
• Immediate RLN reconstruction demonstrated positive trends in voice quality and reduced aspiration.

Conclusions:

• Immediate microsurgical reconstruction of the recurrent laryngeal nerve (RLN) appears to yield excellent postoperative phonatory function.
• Further multicenter studies are warranted to validate these findings.
• Prompt surgical intervention for RLN injury can mitigate long-term vocal dysfunction.