A narrative review of current therapies in unilateral recurrent laryngeal nerve injury caused by thyroid surgery

Tian, Hedi; Pan, Jun; Chen, Linghui; Wu, Yijun

doi:10.21037/gs-21-708

Cited by 9 publications

(7 citation statements)

References 67 publications

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“…Recurrent laryngeal nerve (RLN) injury impairs vocal cord mobility, resulting in incomplete glottic closure, potentially causing hoarseness, dysphagia, and sometimes aspiration pneumonia, decreasing the patient's quality of life. RLN injury has several causes, including thyroid cancer surgery 1–4 . If thyroid cancer or metastatic lymph nodes directly invade the RLN, it may be resected for curative oncological purposes.…”

Section: Introductionmentioning

confidence: 99%

“…In such cases, immediate intraoperative reconstructive procedures such as direct anastomosis (DA) and ansa cervicalis to RLN anastomosis (ARA) may improve speech function and prevent aspiration compared to delayed repair procedures such as injection laryngoplasty and medialization thyroplasty. From this perspective, immediate intraoperative repair of RLN has more advantages than disadvantages and 5,6 should be performed whenever possible 1,2,7,8 …”

Section: Introductionmentioning

confidence: 99%

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Artificial Nerve Conduit for Recurrent Laryngeal Nerve Reconstruction in Thyroid Surgery

et al. 2023

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Objective Oncological reconstruction of the recurrent laryngeal nerve (RLN) is sometimes necessary for RLN invaded by thyroid cancer. There have been no case reports of RLN reconstruction using artificial nerve conduits, which are often used for peripheral nerves. In this study, we retrospectively evaluate the feasibility, safety, and efficacy of a collagen conduit with collagen filaments for RLN reconstruction cases at our hospital. Methods Artificial nerve conduits were used in seven cases of RLN reconstruction. Two patients had preoperative unilateral vocal cord paralysis with severe vocal cord atrophy, and two had vocal cord paresis without atrophy. The remaining three patients had functional vocal cords before surgery that had to be resected via surgery due to thyroid cancer infiltration of the RLN. Reconstruction was performed using RENERVE®, which is a collagen conduit. Voice examination and laryngeal endoscopy were performed 1, 3, and 12 months after surgery. Results There was no improvement in the phonetics of the two patients with vocal cord atrophy before surgery. In the remaining five cases, three with functional vocal cords improved to preoperative values, and two with vocal cord paresis improved to greater than preoperative values. Conclusion We report the first case series using an artificial nerve conduit for human RLN reconstruction. In cases of RLN resection when the patient has good voice quality pre‐operatively, reconstruction of the RLN using an artificial nerve may be a favorable option in cases where direct anastomosis or ansa cervicalis to RLN anastomosis cannot be performed. Level of Evidence 4 Laryngoscope, 133:1773–1779, 2023

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Artificial Nerve Conduit for Recurrent Laryngeal Nerve Reconstruction in Thyroid Surgery

et al. 2023

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“…Tissue engineering has been researched extensively in several regenerative techniques, including cartilage, neuron, cardiac, and bone regeneration [ 7 , 8 , 9 , 10 ]. Nonetheless, previous studies [ 11 , 12 , 13 , 14 ] have identified vocal fold fibroblasts, muscle progenitor cells, embryonic stem cells (ESCs), bone marrow mesenchymal stem cells (BMMSCs), and adipose stem cells (ASCs) with or without the use of a scaffold as a delivery vehicle for vocal fold regeneration. This study seeks to outline the most recent advancements in injectable biomaterials that transport biomolecules and cells for regeneration purposes and to identify future directions for tissue engineering–based treatment of glottic insufficiency.…”

Section: Introductionmentioning

confidence: 99%

Tissue Engineering as a Promising Treatment for Glottic Insufficiency: A Review on Biomolecules and Cell-Laden Hydrogel

Lokanathan

Baki

et al. 2022

Biomedicines

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Glottic insufficiency is widespread in the elderly population and occurs as a result of secondary damage or systemic disease. Tissue engineering is a viable treatment for glottic insufficiency since it aims to restore damaged nerve tissue and revitalize aging muscle. After injection into the biological system, injectable biomaterial delivers cost- and time-effectiveness while acting as a protective shield for cells and biomolecules. This article focuses on injectable biomaterials that transport cells and biomolecules in regenerated tissue, particularly adipose, muscle, and nerve tissue. We propose Wharton’s Jelly mesenchymal stem cells (WJMSCs), induced pluripotent stem cells (IP-SCs), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), insulin growth factor-1 (IGF-1) and extracellular vesicle (EV) as potential cells and macromolecules to be included into biomaterials, with some particular testing to support them as a promising translational medicine for vocal fold regeneration.

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“…Given the morbidity that RLN injury carries for patients, there exists a number of conservative and surgical therapies for RLN healing (7), as well as a growing interest in innovative therapies involving electrical stimulation and tissue engineering (8,9). However, these therapies are limited physiologically, as axonal regeneration is generally limited and slow (10).…”

Section: Introductionmentioning

confidence: 99%

“…3,4 The introduction of intraoperative nerve monitoring aimed at RLN preservation has been largely equivocal based on recent meta-analyses, and the incidence of RLN injury during thyroid surgery has remained relatively stable. 5,6 Given the morbidity that RLN injury carries for patients, there exists a number of conservative and surgical therapies for RLN healing, 7 as well as a growing interest in innovative therapies involving electrical stimulation and tissue engineering. 8,9 However, these therapies are limited physiologically, as axonal regeneration is generally limited and slow.…”

mentioning

confidence: 99%

Immediate Intraoperative Microsurgical Repair of the Recurrent Laryngeal Nerve: A Fifteen-Year Institutional Experience

McGraw

Bascone

Jaimez

et al. 2022

J Reconstr Microsurg Open

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Background: Recurrent laryngeal nerve (RLN) injury carries significant morbidity. Microsurgical repair of the RLN has proven promising for enhancing patient recovery of vocal function; however, data remains limited. Methods: This retrospective cohort study included patients who underwent RLN repair from 2007 to 2022. Demographics and medical history were collected. The location and etiology of RLN injury, as well as the repair technique, were collected. Follow-up data was collected at the initial post-operative visit, at six months, and at one year. Hoarseness was classified as mild, moderate, or severe. Of patients who underwent nasopharyngolaryngoscopy (NPL) following repair, the glottic gap was measured. Vocal interventions performed were also recorded. This study utilized descriptive statistical methods. Results: Eleven patients underwent RLN repair. All patients underwent immediate repair. Fifty-four percent (N=6) of RLN injuries resulted from tumor inflammation or nerve encasament. Eighty-two percent (N=9) underwent direct RLN coaptation, 9% (N=1) underwent vagus-RLN anastomosis, and 9% (N=1) underwent an interposition nerve graft. Technical success was 100%. Seventy-three percent (N=8) required otolaryngology referral, and of those, 50% (N = 4) required intervention. At initial evaluation, 91% (N=10) suffered from mild to severe hoarseness, and of patients who underwent NPL, all had a glottic gap. At one year, 82% of patients (N=9) improved to having mild to no appreciable hoarseness. Of the patients who underwent NPL, 62% (N=5) had closure of the glottic gap. Conclusion: Patients undergoing repair of the RLN following injury showed excellent recovery of vocal function and resolution of glottic gap at one year

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A narrative review of current therapies in unilateral recurrent laryngeal nerve injury caused by thyroid surgery

Cited by 9 publications

References 67 publications

Artificial Nerve Conduit for Recurrent Laryngeal Nerve Reconstruction in Thyroid Surgery

Artificial Nerve Conduit for Recurrent Laryngeal Nerve Reconstruction in Thyroid Surgery

Tissue Engineering as a Promising Treatment for Glottic Insufficiency: A Review on Biomolecules and Cell-Laden Hydrogel

Immediate Intraoperative Microsurgical Repair of the Recurrent Laryngeal Nerve: A Fifteen-Year Institutional Experience

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