Functional outcome after recurrent laryngeal nerve injury following thoracic aortic surgery

Recurrent laryngeal nerve injury is a recognized complication of aortic surgery, yet data on long-term functional outcomes remain limited. This study aimed to evaluate the incidence of recurrent laryngeal nerve injury and to assess voice recovery after thoracic aortic surgery.

Single-centre retrospective analysis included adult patients undergoing aortic arch or thoracoabdominal aortic surgery between 2001 and 2024. Recurrent laryngeal nerve injury was diagnosed by postoperative vocal cord paralysis. Aortic arch surgery included partial and total arch replacement, while thoracoabdominal surgery involved the proximal descending aorta. The primary endpoint was full voice recovery. Secondary endpoints included recovery of normal vocal cord mobility, residual dysphonia, the need for voice therapy, and vocal cord interventions.

Among 2,983 patients undergoing aortic surgery, 70 (2.3%) were diagnosed with postoperative recurrent laryngeal nerve injury. Median follow-up was 17 [IQR: 7-25] months. The incidence of recurrent laryngeal nerve injury was 1.7% after arch surgery and 5.3% after thoracoabdominal procedures. At final follow-up, 34 patients (50%) achieved full voice recovery, while 20 (30%) had mild dysphonia, 9 (13%) moderate dysphonia, and 5 (7%) severe dysphonia. Voice therapy was performed in 49 (70%) patients, and 10 (14%) required additional vocal cord interventions.

In this large cohort, the incidence of recurrent laryngeal nerve injury after aortic surgery was lower than previously reported. Functional outcomes were favourable, with most patients achieving full or near-complete voice recovery through conservative or interventional management. Structured follow-up and multidisciplinary care remain essential to optimize outcomes after recurrent laryngeal nerve injury.