Long-term phonation status after recurrent laryngeal nerve reconstruction

Patients undergoing recurrent laryngeal nerve resection and reconstruction usually recover phonatory function within a year. However, their long-term outcomes remain unclear. This study assessed phonatory function over more than 10 years.

Data of a cohort of 212 patients (165 female, 47 male) who underwent recurrent laryngeal nerve reconstruction between February 2005 and August 2022 were retrospectively analyzed. Maximum phonation time and mean flow rate were measured preoperatively and, periodically, postoperatively. The Voice Handicap Index-10 questionnaire was administered at patients' final visits. Postoperative periods were divided into period I (>6 months-2 years), period II (>2-10 years), and period III (>10 years).

Preoperatively, 100 patients (47.2%) had vocal cord paralysis. For both sexes, patients with preoperative vocal cord paralysis had significantly longer maximum phonation times and smaller mean flow rates in period I than they had preoperatively; these values further improved in period II, with improvements maintained in period III. Patients without vocal cord paralysis showed recovery in voice after recurrent laryngeal nerve reconstruction; however, in both sexes, their maximum phonation times and mean flow rates in period I did not reach preoperative levels. Maximum phonation time and mean flow rate improved in period II in both sexes, with these improvements being maintained in period III. The Voice Handicap Index-10 score improved over time in all patients except female patients without preoperative vocal cord paralysis, whose best score was obtained in period I.

In patients who required recurrent laryngeal nerve resection, reconstructive surgery restored phonatory function early. Further modest improvement was observed over 10 years, persisting beyond 10 years.