[Treatment of recurrent laryngeal nerve paralysis by several types of nerve suture]

Although simple neurorrhaphy of the injured recurrent laryngeal nerve usually results in impaired movements of the vocal cord because of misdirected regeneration, phonation recovers because the vocal cord maintains tension during phonation. Simple neurorrhaphy is possible in only a few of patients who have had their nerve severed because of thyroid surgery for thyroid cancer. We tried free nerve grafting, vagus nerve-recurrent nerve suture and ansa cervicalis-recurrent nerve suture as well as the simple neurorrhaphy in 3, 1, 1 and 3 patients, respectively. All of the 8 patients who had repair of the recurrent nerve recovered from hoarseness. Maximum phonation times of these patients ranged from 17 to 41 sec with a mean of 26.5 +/- 9.6 sec, which were significantly longer than those of 23 patients without nerve repair. Each modality of the repair obtained similar good results, although the patient who underwent vagus-recurrent suture required a longer period for recovery. These results indicate that not only simple neurorrhaphy of the recurrent nerve but also free nerve grafting, vagus nerve-recurrent nerve suture, or ansa cervicalis-recurrent suture are effective in recovery of the phonation in patients with peripheral and unilateral recurrent nerve paralysis.